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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Validation of 2006 WHO prediction scores for true HIV infection in children less than 18 months with a positive serological HIV test
PLoS ONE, Volume 4, No. 4, Article e5312, Year 2009
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Description
Introduction: All infants born to HIV-positive mothers have maternal HIV antibodies, sometimes persistent for 18 months. When Polymerase Chain Reaction (PCR) is not available, August 2006 World Health Organization (WHO) recommendations suggest that clinical criteria may be used for starting antiretroviral treatment (ART) in HIV seropositive children <18 months. Predictors are at least two out of sepsis, severe pneumonia and thrush, or any stage 4 defining clinical finding according to the WHO staging system. Methods and Results: From January 2005 to October 2006, we conducted a prospective study on 236 hospitalized children <18 months old with a positive HIV serological test at the national reference hospital in Kigali. The following data were collected: PCR, clinical signs and CD4 cell count. Current proposed clinical criteria were present in 148 of 236 children (62.7%) and in 95 of 124 infected children, resulting in 76.6% sensitivity and 52.7% specificity. For 87 children (59.0%), clinical diagnosis was made based on severe unexplained malnutrition (stage 4 clinical WHO classification), of whom only 44 (50.5%) were PCR positive. Low CD4 count had a sensitivity of 55.6% and a specificity of 78.5%. Conclusion: As PCR is not yet widely available, clinical diagnosis is often necessary, but these criteria have poor specificity and therefore have limited use for HIV diagnosis. Unexplained malnutrition is not clearly enough defined in WHO recommendations. Extra pulmonary tuberculosis (TB), almost impossible to prove in young children, may often be the cause of malnutrition, especially in HIV-affected families more often exposed to TB. Food supplementation and TB treatment should be initiated before starting ART in children who are staged based only on severe malnutrition. © 2009 Peltier et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC2669178/bin/pone.0005312.s001.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC2669178/bin/pone.0005312.s002.doc
Authors & Co-Authors
Peltier, Alexandra
Rwanda, Kigali
Esther Project/luxembourg Lux-development
Omes, Christine
Rwanda, Kigali
Esther Project/luxembourg Lux-development
Ndimubanzi, Patrick Cyaga
Rwanda, Kigali
Esther Project/luxembourg Lux-development
Ndayisaba, Gilles François
Rwanda, Kigali
Esther Project/luxembourg Lux-development
Stulac, Sara N.
United States, Boston
Partners in Health
Arendt, Vic
Rwanda, Kigali
Tracplus - Center for Infectious Disease Control
Courteille, Olivier
Rwanda, Kigali
Esther Project/luxembourg Lux-development
Muganga, Narcisse
Rwanda, Kigali
University Hospital
Kayumba, Kizito
Unknown Affiliation
van den Ende, Jef J.
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Belgium, Edegem
Universitair Ziekenhuis Antwerpen
Statistics
Citations: 15
Authors: 10
Affiliations: 7
Identifiers
Doi:
10.1371/journal.pone.0005312
e-ISSN:
19326203
Research Areas
Food Security
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study