CLINICAL PROFILE OF OPPORTUNISTIC INFECTIONS IN HIV INFECTED CHILDREN AND ITS CORRELATION WITH CD4 COUNT: A MULTICENTRIC STUDY FROM EASTERN INDIA

Seba Ranjan Biswal; Sunil K. Agarwalla; Shubhankar Mishra

Volume : VII, Issue : VIII, August - 2017

CLINICAL PROFILE OF OPPORTUNISTIC INFECTIONS IN HIV INFECTED CHILDREN AND ITS CORRELATION WITH CD4 COUNT: A MULTICENTRIC STUDY FROM EASTERN INDIA

Seba Ranjan Biswal, Sunil K. Agarwalla, Shubhankar Mishra

Abstract :

Background & objective: India harbors world’s third highest number of HIV infected people. Children usually have higher viral load, weaker immune system, variable latency period, fewer opportunistic infections & fewer medicines approved for management. Knowledge of the clinical profile in HIV infected children will help in better understanding of the disease and management. Hence the present study was done with an objective to study the clinical presentation, opportunistic infections, WHO clinical stage, nutritional status and its correlation with CD4 count.

Method: 75 children below 14 years of age and seropositive for HIV were included in this Detailed clinical evaluation and relevant laboratory investigations were done as per the Performa. Based on clinical presentations, the children were categorized into WHO clinical stages. Weight for age was used to grade the PEM. They were further classified based on CD4 count values in accordance with WHO classification of immunodeficiency.

Results: In the study 30% of children were in the age group of 4 to 7 years. The mean age of presentation was 7.12 years. 56% of children presented with WHO clinical stage III & 30% with stage IV at first visit. Female children had higher mean CD4 count (488 cells/cmm) than male children (340 cells/cmm). Vertical transmission was the predominant mode of transmission (92%). Anemia (48%), fever (42%) and cough (34%) were common symptoms. Pulmonary tuberculosis (28%) was the most common opportunistic infection seen at mean CD4 count of 267 ± 5.37, Oral candidiasis at CD4 count of 364.8±6.5, Pneumocystis jirovecii pneumonia at CD4 count of 261.25±0.8. Children with opportunistic infection had lesser CD4 count. With the increasing grades of WHO clinical stage there was CD4 count decline, the severity of immune suppression increases with increasing WHO clinical stages. The severity of PEM increases when CD4 count decreases.

Interpretation & Conclusion: The manifestations of HIV infection in children are protean and mimic a number of other illnesses. Perinatal transmission is the common mode of acquiring HIV in pediatric age group. Anaemia, fever & cough were the common presenting clinical features. Tuberculosis is the most common opportunistic infection in HIV infected children. As WHO clinical stage and grade of PEM increases CD4 count decreases. CD4 count is a reliable marker of disease progression in HIV infected children.