Clinical profile and follow-up of HIV infection in pediatric age group beyond 18 months up to 13 years at tertiary level hospital

Background: An increasing number of HIV infected children have been reported as spread of HIV in adults are showing increasing trend in India. We reported the clinical manifestation, laboratory parameters and follow up of these children. Aim: To study the clinical profile follow up of paediatric patients admitted with HIV in the age gruop18 months to 13 years for a period of 1 year. Materials and methods: This Prospective study was conducted at tertiary care centre at Gandhi Hospital in association with ART centre, Ganhi Hospital, Secunderabad over a period of one year (January 2013 - December 2013). Over 100 consecutive patients suspected and later confirmed by TRIDOT & HIV EIA COOMB were included in the study after obtaining written consent from guardian of the patients. A detailed history, thorough clinical examination and laboratory investigations were carried out. ART & ATT therapy were given according to guidelines and followed up. Results: Of the 100 cases, 55 were males and 45 were females. Immunization status of these children included 20%completely immunised, 52% partially immunized and unknown in 28. Clinical manifestation like, anemia was seen in 95 cases, 91 cases had PEM with 47.25% were in gr 4, PGL (38), fever (36), respiratory (28), diarrhoea (15). Less commonly seen were CNS and chronic ottorhea. Most common opportunistic infections were tuberculosis (16) and candidiasis (16) with giardiasis (3) and herpes zoster (2). Of the 100 cases enrolled, 11 were lost to follow up and 3cases died. Mean weight gain after 6 months 1.6 SD and 2.8 SD at 12 months. On laboratory investigations 95 cases had Hb <2SD, 21 had mantoux positive (>5 mm), abnormal chest X-ray in 23 cases. Conclusion: Most children were in the age group of 1-5 years with mean age of presentation of 5.5 years. Mild bias towards male patients is noted. Perinatal mode is the only mode of transmission, no other modes noted. Most of the children presented to us in a partially immunized status and others' status was not known. Common presentations - PEM, anemia, skin manifestations, nutritional deficiencies, prolonged fever, systemic manifestations – PGL; respiratory infections like pneumonia, TB; chronic diarrhoea. CNS manifestations were uncommon and renal problems, malignancies were not noted in our study. Amongst opportunistic infections, TB involving various organs and candidiasis were seen in maximum number of patients. Our study concluded that administration of nevirapine based ART regimes for HIV-1 infected children is feasible in resource limited settings. There was improvement in growth parameters with the use of this therapy and prevention of deterioration in immune status.