Utility of clinical parameters to identify HIV infection in infants below ten weeks of age in South Africa : a prospective cohort study

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dc.contributor.authorJaspan, Heather B.
dc.contributor.authorMyer, Landon
dc.contributor.authorMadhi, Shabir A.
dc.contributor.authorViolari, Avy
dc.contributor.authorGibb, Diana M.
dc.contributor.authorStevens, Wendy S.
dc.contributor.authorDobbels, Els
dc.contributor.authorCotton, Mark F.
dc.date.accessioned2012-01-24T14:08:09Z
dc.date.available2012-01-24T14:08:09Z
dc.date.issued2011-11
dc.date.updated2012-01-13T12:09:54Z
dc.descriptionThe original publication is available at http://www.biomedcentral.com/1471-2431/11/104en_ZA
dc.descriptionPublication of this article was funded by the Stellenbosch University Open Access Fund.
dc.description.abstractABSTRACT: Background: As HIV-infected infants have high mortality, the World Health Organization now recommends initiating antiretroviral therapy as early as possible in the first year of life. However, in many settings, laboratory diagnosis of HIV in infants is not readily available. We aimed to develop a clinical algorithm for HIV presumptive diagnosis in infants < 10 weeks old using screening data from the Children with HIV Early Antiretroviral therapy (CHER) study in South Africa. HIV-infected and HIV-uninfected exposed infants < 10 weeks of age were identified through Vertical Transmission Prevention programs. Clinical and laboratory data were systematically recorded, groups were compared using Kruskal-Wallis, analysis of variance (ANOVA), and Fisher's exact tests. Receiver Operating Characteristic (ROC) curves were compiled using combinations of clinical findings. Results 417 HIV-infected and 125 HIV-exposed, uninfected infants, median age 46 days (IQR 38-55), were included. The median CD4 percentage in HIV-infected infants was 34 (IQR 28-41)%. HIV-infected infants had lower weight-for-age, more lymphadenopathy, oral thrush, and hepatomegaly than exposed uninfected infants (Adjusted Odds Ratio 0.51, 8.8, 5.6 and 23.5 respectively; p < 0.001 for all). Sensitivity of individual signs was low (< 20%) but specificity high (98-100%). If any one of oral thrush, hepatomegaly, splenomegaly, lymphadenopathy, diaper dermatitis, weight < 50th centile are present, sensitivity for HIV infection amongst HIV-exposed infants was 86%. These algorithms performed similarly when used to predict severe immune suppression. Conclusions A combination of physical findings is helpful in identifying infants most likely to be HIV-infected. This may inform management algorithms and provide guidance for focused laboratory testing in some settings, and should be further validated in these settings and elsewhere.en_ZA
dc.description.sponsorshipNational Institute of Allergy and Infectious Diseases (NIAID) of the US National Institutes for Health (NIH), through the Comprehensive International Program of Research on AIDS (CIPRA) network, grant number U19 AI53217.en_ZA
dc.description.versionPeer Revieweden_ZA
dc.format.extent7 p.
dc.identifier.citationJaspan, H. B. et al. 2011. Utility of clinical parameters to identify HIV infection in infants below ten weeks of age in South Africa: a prospective cohort study. BMC Pediatrics, 11(1):104.en_ZA
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2431-11-104
dc.identifier.urihttp://hdl.handle.net/10019.1/19378
dc.language.isoen_ZAen_ZA
dc.language.rfc3066en
dc.publisherBioMed Centralen_ZA
dc.rights.holderJaspan et al.; licensee BioMed Central Ltd.en_ZA
dc.subjectHIV-infected infants -- Antiretroviral therapyen_ZA
dc.subjectHIV-infected infants -- Symptomsen_ZA
dc.subjectMedical protocols -- HIV-positive infantsen_ZA
dc.subjectVertical transmission prevention programmes -- HIV-infected infants -- South Africa -- Researchen_ZA
dc.subjectChildren -- Diseases -- Symptoms -- Researchen_ZA
dc.subjectInfants -- Diseases -- Symptoms -- Researchen_ZA
dc.titleUtility of clinical parameters to identify HIV infection in infants below ten weeks of age in South Africa : a prospective cohort studyen_ZA
dc.typeArticleen_ZA
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