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

2020 ◽  
pp. 1-8
Author(s):  
Archana Mishra ◽  
Narendra Nath Soren ◽  
Sristi Ganguly
Keyword(s):  
Opportunistic Infections ◽  
Nutritional Assessment ◽  
Clinical Stage ◽  
Clinical Manifestations ◽  
Cd4 Count ◽  
Pediatric Hiv ◽  
Clinical Staging ◽  
Categorical Variables ◽  
Chi Square ◽  
Cd4 Counts

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.

A proposal for basic management of HIV disease in West Africa: use of clinical staging and haemogram data

1998 ◽  
Vol 9 (8) ◽  
pp. 463-470 ◽  
Author(s):  
E Ledru ◽  
S Diagbouga ◽  
N Meda ◽  
P T Sanou ◽  
H Dahourou ◽  
...  
Keyword(s):  
Lymphocyte Count ◽  
Opportunistic Infections ◽  
Clinical Stage ◽  
Cross Sectional Study ◽  
Clinical Staging ◽  
Chronic Diarrhoea ◽  
Hiv Disease ◽  
Cross Sectional ◽  
Cd4 Counts ◽  
African People

Summary: Our objective was to propose a strategy to screen HIV infected African people for biological immunodeficiency easily. In a cross sectional study, we analysed the patterns of diseases and of CD4 counts among 266 HIV infected adults. Peripheral facial paralysis and chronic cutaneo mucous diseases were the earlier B stage diseases. Pulmonary tuberculosis was close to B stage diseases, and chronic diarrhoea was borderline between B and C stages. Cachexia was the most frequent C stage symptom 47.8 . Ninety per cent of CDC C stage people had CD4 counts below 350 mul, whereas only 75 had CD4 counts below 200 mul. Regression analysis identified the lymphocyte count, clinical stage and platelet count as predictors of CD4 count below 350 mul. A simple score lymphocyte count 2500 mul and clinical stage B is proposed to determine this CD4 threshold positive predictive value: 83 and to determine those patients needing treatment to prevent wasting and opportunistic infections.

scholarly journals Clinical spectrum of paediatric HIV infection in a tertiary care centre in South India

2018 ◽  
Vol 5 (4) ◽  
pp. 1348
Author(s):  
Santhosh Kumar K. K. ◽  
Narayanappa D. ◽  
Ravi M. D. ◽  
Jagadish Kumar K.
Keyword(s):  
Hiv Infection ◽  
Vertical Transmission ◽  
Opportunistic Infections ◽  
Nutritional Assessment ◽  
Oral Candidiasis ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Pediatric Hiv ◽  
Hiv Encephalopathy ◽  
Paediatric Hiv

Background: The global burden of paediatric HIV and acquired immune deficiency syndrome (AIDS) remains a challenge for healthcare workers around the world, particularly in developing countries. The objective of this study is to describe the spectrum of HIV infection in children including the mode of transmission, clinical manifestations and opportunistic infections associated with HIV infection.Methods: Confirmed HIV seropositive children aged between 18 months to 19 years admitted to paediatric ward of JSS hospital, Mysore during two-year period were enrolled in this prospective observational study. Detailed history, socio-demographic characteristics and clinical manifestations were recorded in the predesigned performa. Nutritional assessment, complete physical, systemic and neurological examination was performed at the time of admission and was supplemented with ancillary investigations. Patients were correlated with modified WHO clinical case definition for AIDS and categorized as per revised CDC NABC classification of pediatric HIV infection.Results: Forty HIV-infected children were enrolled: with mean age of 4.5 years. Vertical transmission was the predominant mode of HIV transmission (97.5%). Most of the children were severely symptomatic belonging to category-C of NABC classification. Common clinical manifestations noted were failure to thrive (45%), recurrent respiratory infections (42%), bacterial skin infection (36%), recurrent otitis (42.5%), papulo-pruritic dermatitis (22%), hepatosplenomegaly (85%), lymphadenopathy (45%) and HIV encephalopathy (52%). The common opportunistic infections observed were pulmonary tuberculosis (45%), recurrent diarrhoea (35%), oral candidiasis (30%). The rare presentations of HIV noted were chronic thrombocytopenia and a case of dilated cardiomyopathy.Conclusions: Vertical transmission was the major route of HIV infection. HIV encephalopathy was more common among severely affected children. Tuberculosis was the commonest opportunistic infection.

scholarly journals Hematological abnormalities in HIV infected individuals in correlation to CD4 counts and ART status

2016 ◽  
Vol 7 (4) ◽  
pp. 14-18 ◽  
Author(s):  
R Raman Thulasi ◽  
D Manimaran ◽  
G Hemanathan ◽  
Tameem Afroz ◽  
Radha Sagar
Keyword(s):  
Opportunistic Infections ◽  
Hematological Parameters ◽  
Cd4 Count ◽  
Health Concern ◽  
Medical Sciences ◽  
Cd4 Counts ◽  
Medical Centers ◽  
Hematological Abnormalities ◽  
Set Up ◽  
One Year

Background: HIV is pandemic and remains as a public health concern for many decades. This infection though associated with many opportunistic infections and neoplasms, it is further complicated with marked hematological abnormalities. The aim of this study is to determine the magnitude & severity of hematological abnormalities in HIV infected individuals and also to analyze these abnormalities in correlation with the CD4 counts. We also compared these hematological abnormalities in patients on ART and those not on ART.Materials and Methods: The study was conducted for a period of one year, on 120 HIV positive cases including both patients on ART & not on ART. Controls with similar age and sex distribution was set up. The blood samples were collected and processed in an automated cell counter. The parameters were tabulated and analyzed with respect to CD4 count & ART status.Results: Among the total of 120 HIV cases, 77% had anemia, 21% had leucopenia and 5% had thrombocytopenia. The magnitude and severity of anemia, leucopenia, thrombocytopenia and other parameters was found to be more in patients not on ART, when compared to patients on ART. Similarly, the magnitude and severity of most of hematological abnormalities were inversely proportional to the CD4 count in non-ART cases but not with cases on ART.Conclusion: The basic hematological parameters can be used as a prospective screening test to assess the severity and progression of HIV infection when CD4 count is not available. These parameters can also be used to assess the response to anti-retroviral treatment. Therefore, these basic hematological investigations readily available at all medical centers are of great use while treating HIV infected patients.Asian Journal of Medical Sciences Vol.7(4) 2016 14-18 

scholarly journals Body mass index increases CD4+ count in HIV/AIDS patients on first-line therapy

2020 ◽  
Vol 39 (2) ◽  
pp. 121
Author(s):  
Mirna Widiyanti ◽  
Moch Irfan Hadi ◽  
Mei Lina Fitri Kumalasari ◽  
Evi Iriani Natalia ◽  
Dedi Ananta Purba ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Antiretroviral Therapy ◽  
Body Mass ◽  
Influencing Factor ◽  
Clinical Stage ◽  
Cd4 Count ◽  
First Line ◽  
Aids Patients ◽  
Cd4 Counts ◽  
Hiv Aids

Background<br />The body mass index (BMI) may contribute somewhat to drug metabolism, thus affecting the efficacy of antiretroviral therapy (ART). CD4+ counts   in people infected with HIV are essential in determining the stage of the disease, initiation of antiretroviral therapy, opportunistic infections and evaluating treatment outcomes. The aim of this study was to determine the association of BMI and clinical stage with CD4+ counts in HIV patients seeking treatment using first-line antiretroviral therapy (ART).<br /><br />Methods<br />An analytic study with a cross-sectional approach was conducted involving 251 HIV/AIDS patients who had received first-line antiretrovirals over six months. BMI, clinical staging according to WHO and CD4 + were collected. Multiple linear regression was used to evaluate the relationship between BMI, clinical stage and CD4+.<br /><br />Results<br />Among the enrolled patients, the median age was 36 years, 135 (55%) of the patients was female, 102 (40.6%) was overweight/obese, 161 (64.1%) was in stage 3 of the disease, and the median CD4+ count was 389 cells/mm3. Multiple linear regression test showed two variables with a significant effect on CD4+ count, namely BMI (B=69.247; 95 % CI : 42.886-95.608) and clinical stage (B=61.590; 28.910-94.270). BMI was the most influencing factor for CD4+ count (β=0.307) compared to clinical stage (β=0.216). <br /><br />Conclusions<br />Body mass index was the most influencing factor for CD4 + counts of HIV/AIDS patients. Regular ART can increase CD4+ counts and maintain the health of HIV/AIDS patients.

scholarly journals A study of clinical spectrum of opportunistic infections in HIV infected children and its correlation with CD4 count and anti-retroviral therapy

2017 ◽  
Vol 4 (4) ◽  
pp. 1485
Author(s):  
Vishal Manohar Jadhav ◽  
Yashwant Raghu Gabhale ◽  
Mamatha Murad Lala ◽  
Nikita Dilip Shah ◽  
Mamta Vijay Manglani
Keyword(s):  
Opportunistic Infections ◽  
Molluscum Contagiosum ◽  
Cd4 Count ◽  
Clinical Spectrum ◽  
Pneumocystis Jiroveci ◽  
Female Ratio ◽  
Cd4 Counts ◽  
Pneumocystis Jiroveci Pneumonia ◽  
High Index Of Suspicion ◽  
Male To Female

Background: To determine the clinical spectrum and prevalence of opportunistic infections (OIs) in HIV infected children and correlate the occurrence of opportunistic infections with their CD4 count and Anti-retroviral treatment (ART).Methods: A total of 100 HIV infected children diagnosed with opportunistic infections were included in the study. Demographic details, clinical examination and relevant investigations were done for all the children. Clinical spectrum of OIs and HIV staging was recorded. CD4 counts were done at baseline and were repeated at 6 monthly intervals.Results: Mean age of the patients was 7.08±3.48 years (ranging from 6 months to 15 years) at enrollment with male to female ratio of 1.2:1. Fever (91%) was a common presenting symptom followed by weight loss (74%), cough (37%), abdominal pain (29%) and breathlessness (16%). CD4 count was significantly associated with presence of opportunistic infection in the study group. Tuberculosis - pulmonary (32%) and extra-pulmonary (29%) was the most common oppurtunistic infections, followed by oral thrush (13%), Herpes zoster (10%), Molluscum Contagiosum (9%), Pneumocystis jiroveci pneumonia (3%), Parvovirus infection (3%) and Pruritic Papular Eruptions (2%). 70% children were on ART as per clinical and immunological staging of HIV.Conclusions: Low CD4 count is significantly associated with severe opportunistic infections, therefore drop in CD4 count should serve as an alarming signal for the treating physician. High index of suspicion is required to detect opportunistic infections and therefore CD4 counts should be done more frequently to predict occurrence of OIs. 

scholarly journals Prevalence of opportunistic infections in HIV-positive patients in Bahrain: a four-year review (2009-2013)

2015 ◽  
Vol 9 (01) ◽  
pp. 060-069 ◽  
Author(s):  
Nermin Kamal Saeed ◽  
Eman Farid ◽  
Afaf E Jamsheer
Keyword(s):  
Bacterial Infections ◽  
Opportunistic Infections ◽  
Arab World ◽  
Cd4 Count ◽  
Hiv Positive ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Cd4 Counts ◽  
Significant Difference ◽  
Streptococcus Milleri ◽  
Mycobacteria Other Than Tuberculosis

Introduction: This study aimed to examine the prevalence of opportunistic infections in HIV-infected patients in Bahrain and its relation to absolute CD4 count, CD4%, and CD4/CD8 ratio. Methodology: This retrospective cohort study used laboratory records (January 2009 - May 2013) from a major hospital in Bahrain. Opportunistic infections (OIs); absolute CD4 counts, CD4%, and CD4/CD8 ratio were recorded. Results: CD4% and absolute CD4 count in HIV patients with associated infections (157 ± 295) was significantly lower than in those without associated infections (471 ± 285) (p < 0.001). There was no significant difference in CD4/CD8 ratio between the two groups. Infection with Staphylococcus aureus was the commonest infection, present in 9.8% of total HIV-infected patients and 28.7% of members of the AIDS patient group with OIs, followed by yeast infections (9.2% and 27.2%, respectively). Mycobacterium tuberculosis was present in 3.6% of total HIV-infected patients and 10.6% of the group with OIs, while mycobacteria other than tuberculosis (MOTT) was present in 2.5% and 7.5%, respectively. Pneumocystis jirovecii pneumonia (PCP) was observed in 5.1% and 15.1%, respectively. Herpes simplex II (HSV-II) was observed in 3% and 9%, respectively, while Cytomegalovirus antigenemia was only present in 2% and 6%, respectively. Streptococcus pneumoniae, Streptococcus milleri, Stenotrophomonas maltophilia, and Citrobacter species were bacterial infections observed least frequently. Conclusions: Studying the pattern of OIs in HIV-infected patients in Bahrain is of paramount importance due to the scarcity of data in the Arab world. This will help to improve physicians’ awareness to improve care of HIV-infected patients.

Drug Metabolism and Disposition Genes in Israeli HIV Patients: MDR1 and CYP3A4 Polymorphisms May Affect Susceptibility to HIV but Not the Course of the Disease.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1434-1434
Author(s):  
Meirav Kedmi ◽  
Sara Bar Cohen ◽  
Michelle Hauzi ◽  
Shlomo Maayan ◽  
Deborah Rund
Keyword(s):  
Hiv Infection ◽  
Ethnic Group ◽  
Ethnic Groups ◽  
Mononuclear Cells ◽  
Opportunistic Infections ◽  
Statistical Significance ◽  
Cd4 Count ◽  
Multidrug Resistance Gene ◽  
Cd4 Counts ◽  
Over Time

Abstract Background: Some studies have suggested a relationship between different alleles of the multidrug resistance gene MDR1, and the course of HIV in treated or untreated patients (pts). It is controvertial whether polymorphisms alter the susceptibility to HIV infectivity. We therefore studied the C3435T polymorphism in MDR1, which may influence HIV. The normal allele has been associated with higher MDR1 activity than the polymorphic allele (Hitzl, 2001). We also studied the A to G polymorphism in the NFSE element of the promoter of the CYP3A4 gene, which metabolizes many important drugs. Methods: 96 pts, of either Ethiopian (57) or Caucasian (39) ethnicity, and 276 controls of these ethnic groups were studied using PCR based techniques. MDR1 activity was analyzed on peripheral blood mononuclear cells of 65 pts using rhodamine extrusion. CD4 counts, clinical course and opportunistic infections were recorded at the Hadassah Hospital AIDS Center where all pts are followed. Our pts are highly compliant with medical therapy and followup. Statistical significance was determined using the Cochrane-Armitage Trends test. Results: We found that the C allele of MDR1 C3435T was highly associated with being an HIV patient (p&lt;0.0001) as compared to controls. The reverse was true for the T allele. This association was found for all patients and also separately for each ethnic group. To analyze if this polymorphism affects the course of HIV, we compared CD4 counts in the patients of both ethnic groups according to genotypes. CD4 counts did not differ according to MDR1 C3435T genotype. Furthermore, C3435T genotypes did not affect the change in CD4 count over time in treated pts. CD4 counts rose following antiretroviral therapy in all pts. Twenty-eight of the pts were positive for HIV infection but were not yet treated. In untreated pts, the TT patients had more severe CD4 deficiency over time compared to CC pts. Our sample size is small, but this concurs with the findings of Lee who found that increased MDR1 activity correlated with decreased viral production (Lee, CG, FASEB J, 2000). Rhodamine extrusion did not vary according to MDR1 C3435T genotype. Opportunistic infections were rare and unaffected by genotype. For the CYP3A4 promoter polymorphism, we found a significantly increased probability of being infected with HIV (p&lt;0.0001) with the presence of the C allele, both in heterozygotes and in homozygotes. There were significantly fewer T alleles among the controls as compared to HIV pts. However when analyzed by ethnic group, this association was only found to be significant for Ethiopians and not for Caucasians (Ethiopians: p&lt; 0.0232 compared to p=0.44). There were no differences found in CD4 count, in treated or untreated patients, or in opportunistic infections according to CYP3A4 genotype. Conclusions: We conclude that for Israeli patients (Ethiopians and Caucasians), susceptibility to HIV infection may be altered according to MDR1 genotype. The C allele was highly associated with infection with HIV for both ethnic groups, as compared to normal controls. For Ethiopians, the CYP3A4 genotype may influence the predisposition to HIV infection (the C allele being associated with being a patient as compared to controls). However, the course of the disease and unsorted lymphocyte MDR1 activity were not influenced by the polymorphisms which we studied.

scholarly journals Assessment of Prevalence of Malnutrition and Its Associated Factors among AIDS Patients from Asella, Oromia, Ethiopia

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Teferi Teklu ◽  
Nitin Mahendra Chauhan ◽  
Firaol Lemessa ◽  
Getu Teshome
Keyword(s):  
Associated Factors ◽  
Opportunistic Infections ◽  
Nutritional Assessment ◽  
Clinical Stage ◽  
Cross Sectional Study ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Cross Sectional ◽  
Sub Saharan ◽  
The Impact

Sub-Saharan Africa remains to be the most heavily affected region by malnutrition, accounting for 23.8% share of the global burden. Undernutrition weakens the immune system, increases the susceptibility to infections, and may worsen the impact on various kinds of diseases. Our aim was to assess undernutrition and its associated factors among AIDS-infected adult patients from Asella, Oromia Region, Ethiopia. An institutional-based cross-sectional study design was employed from June to July 2018. A total number of 519 patients were selected for the proposed work. Data was entered into EpiData, checked, coded, and analyzed using SPSS version 21 software. Descriptive statistics were used to assess the prevalence of undernutrition among patients. Bivariate and multivariate regressions were used to determine the relationship between undernutrition and its associated factors among the study participants. The results of our study showed that the overall prevalence of undernutrition was 18.3%; out of which 12.7% were mildly and 5.6% were moderately to severely undernourished, respectively. Monthly income (AOR: 3.589, 95% CI (1.469-8.768)), whole grain feeding (AOR: 2.979, 95% CI (1.252-7.088)), opportunistic infections in the last six months (AOR: 3.683, 95% CI (3.075-4.411)), clinical stage (AOR: 2.998, 95% CI (1.269-7.083)), and insufficient quality of food (AOR: 3.149, 95% CI (1.339-7.406)) were found to be significantly associated with undernutrition in this study. Therefore, HIV treatment facility should be supported with nutritional assessment, supplementation, counseling, care, and support to patients that may possibly alleviate this predicament.

scholarly journals A study on clinical profile of paediatric HIV infection in the age group of 18 months to 12 years and its correlation with CD4 count

2017 ◽  
Vol 4 (4) ◽  
pp. 1232
Author(s):  
Sureshkumar Ramaswamy ◽  
Murali Thandavarayan ◽  
Sivaraman Thirumalaikumarasamy ◽  
Aparna Sureshkumar
Keyword(s):  
Hiv Infection ◽  
Clinical Symptoms ◽  
Demographic Data ◽  
Clinical Manifestations ◽  
Skin Lesions ◽  
Cd4 Count ◽  
Clinical Profile ◽  
Pediatric Hiv ◽  
Age Group ◽  
College Hospital

Background: The aim of the study was to assess the clinical profile of pediatric HIV infection in the age group of 18 month to 12 years and to correlate the clinical features with their CD4 count.Methods: This descriptive study was conducted over a period of 1 year from October 2007 to October 2008 at Govt. Mohan Kumaramangalam Medical College Hospital, Salem and included 100 children (aged between 18 months-12 years) diagnosed HIV by using rapid antigen tests or ELISA. Demographic data, clinical manifestations correlating with CD4 count and nutritional status of the children were recorded in predesigned proforma and analysed.Results: 100 children were included (males-65 and females-35) in the study. 22 children were asymptomatic and 78 were symptomatic. Clinical symptoms like skin lesions in 29, oral lesions in 10, lymphadenopathy in 46 children were observed. The respiratory (13%), central nervous (12%) and haemotological systems (16%) were most commonly involved organs systems. Children in stage III and IV disease were into Grade I-IV PEM classification (for weight) and majority of stage I-IV children were in Grade II according to Mclaren’s classification (for height).Conclusions: Majority of children with HIV infection presented with various clinical manifestations, malnutrition and immunosuppression. Hence, early identification of the disease and proper management in children helps in improving the immunological status and thereby life span of the child. 

scholarly journals Antiretroviral Service to HIV Patients of low CD4 Count in Seti Zonal Hospital

2009 ◽  
Vol 48 (173) ◽  
Author(s):  
Bidhan Nidhi Paudel ◽  
SR Chaudhary ◽  
S Sharma ◽  
GP Dhunagana ◽  
P Paydel
Keyword(s):  
Late Stage ◽  
Opportunistic Infections ◽  
Clinical Manifestations ◽  
Normal Activity ◽  
Cross Sectional Study ◽  
Cd4 Count ◽  
Hiv Patients ◽  
Cross Sectional ◽  
Select Group ◽  
Hiv Aids

INTRODUCTION:Due to unavailability of vaccine against HIV/AIDS, there are no ways other than relying on ART. We select group of late stage HIV/AIDS with CD4<50 so that opportunistic infections and outcome of patients in this late stage of severe immunosuppression after initiation of ART can be knownMETHODS:A cross sectional study was carried out in 53 HIV patients with CD4 count <50 cells/cu mm blood undergoing ART in Seti Zonal Hospital Dhangadi between December 2006 and May 2008 with objectives to explore the treatment outcome in this late stage of immunosuppression. Only those patients with CD4 count <50 were consecutively selected and recommended for various laboratory test on the basis of which ART regimen were prescribed.RESULTS:Among 53 patients, 42 (79.2%) were males and 11 (20.8%) were females, with predominant age group of 30-40 years (49.1%). Fever (71.7%), diarrhea (56.6%), pneumonia (52.8%), weight loss (52.8%) and oral thrush (33.9%) were found to be the major clinical presentation/Opportunistic infections. 19 (35.8%) patients showed normal activity throughout the treatment period with increase in CD4 count, 10 (19%) were recovered and transferred out. Only 1 (1.8%) showed decrease in CD4 count even after taking ART. Significant relationship was established between the intake of ART and increase in CD4 level (pair t = 7.88, p<0.05).CONCLUSIONS:ART service was found to be efficient enough to increase the CD4 count significantly after 6 months of therapy but the prevalence of OIs/clinical manifestations were sufficiently higher in this group of patients with low CD4 count.Keywords: antiretroviral therapy, cell count, fever, opportunistic infections 

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