Disease in children infected with HIV in Abidjan, Cote d'Ivoire

Abstract

Abstract Objective : To document the range of disease in African children infected with HIV. Design : Necropsy results in consecutive children aged 1 month or more who were HIV positive and in children who were HIV negative for comparison; IgA western blots on serum samples from children under 2 years of age who were positive for HIV-1 to test the validity of routine HIV serology. Setting : Largest hospital in Abidjan, Cote d'Ivoire. Subjects : 78 children who were HIV positive and 77 children who were HIV negative on whom a necropsy was performed; their median ages at death were 18 and 21 months respectively. 36 HIV positive children and 29 HIV negative children were 1-14 months old; 42 HIV positive and 48 HIV negative children were >/=15 months old. Main outcome measures : Cause of death and prevalence of diseases confirmed pathologically. Results : Respiratory tract infections were more common in HIV positive than in HIV negative children (73 (94%) v 52 (68%); P<0.05), and were aetiologically heterogeneous. Pneumocystis carinii pneumonia was found in 11 out of 36 (31%) HIV positive children aged <15 months, but in no HIV negative children. Among older children measles was more common in HIV positive children (8/42 (19%) v 2/48 (4%); P<0.06). Pyogenic meningitis was present in similar proportions of HIV positive and HIV negative children aged <15 months (7/36 (19%) and 7/29 (24%)). In HIV positive children tuberculosis (1/78), lymphocytic interstitial pneumonitis (1/78), and HIV encephalitis (2/78) were rare. Conclusions : There is greater overlap between diseases associated with HIV infection and other common health problems in African children than there is in adults. Compared with adults, HIV positive children had a high prevalence of P carinii pneumonia and a low prevalence of tuberculosis. Measles, but not malaria, was associated with HIV infection. Key messages Key messages In regions with a poor clinical infrastructure necropsy provides information that cannot be obtained otherwise This survey of children aged under 1 month to 12 years who died in Abidjan, Cote d'Ivoire, found that a fifth were positive for HIV infection with a median age at death of 18 months Almost a third of HIV positive children under 15 months old had Pneumocystis carinii pneumonia, a rate similar to that found in affected children in industrialised countries but much higher than the rate in affected adults in Abidjan Measles was more common in children who were HIV positive, suggesting that vaccination would be a feasible intervention