Study of Clinical Manifestations of HIV Infected Children in Relation to CD4 Count

Abstract

Aims: To study the clinical profile of HIV infected children and correlate them with the CD4 count at the time of presentation. Study Design: Hospital based observational study Place and Duration of Study: ART centre of SCBMCH and Department of Pediatrics, SVPPGIP, Cuttack, Odisha during the period October 2017 to September 2019. Methodology: All children aged between 1.5 to 15 years who were confirmed to be HIV positive by ELISA or immunocomb II, either at present or past were included in the study. They were subjected to CD4 count testing, along with nutritional assessment and screened for opportunistic infections, apart from their socio-demographic details. All quantitative variables including age, weight, height, were compared by unpaired t-test. Categorical variables like sex mode of transmission were compared by chi-square test. Variables like clinical staging, immunological staging and CD4 counts were measured at presentation and analyzed with repeated ANOVA at 5% level of significance to allow for multiple comparisons. P<0.05 was considered significant and inferences were drawn. Results: Out of 103 cases, majority belonged to age 4- 7 years and 59.2% were malnourished. 24.3% were asymptomatic, with the most common clinical features noted were fever (65%), cough (47.8%), recurrent diarrhoea (41.8%) and weight loss (40.8%). The incidence of opportunistic infections was 24.3%, with tuberculosis (40%) and herpes zoster (36%) leading the list. Most cases (37.87%) came under WHO clinical stage-III. A significant correlation was found between CD4 count and age, WHO clinical staging, opportunistic infections in the population. Lower CD4 counts were associated with younger age, lower staging and less risk for symptoms and infections. Conclusion: CD4 count is a reliable market to assess the staging and risk for opportunistic infections in pediatric HIV and thus can be used as screening tool for complications/ deterioration in the child, for better management.