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Sero-prevalence of HIV infection in children attending some selected hospitals in Kano Metropolis, Nothern Nigeria
AM Sarari, TO Oyeyi
Bayero Journal of Pure and Applied Sciences , 2010,
Abstract: As the HIV pandemic continues to ravage every aspect of humanity, there is a need to document its prevalence in various health centers situated in Kano. This six-month study reports on the seroprevalence of HIV infection among children less than 15 years of age but above 18 months attending Murtala Muhammad Specialist Hospitals (MMSH), Infectious Diseases Hospital (IDH) and Hasiya Bayero Pediatric Hospital (HBPH) Kano. The voluntary counseling and testing (VCT) of the children of the abovementioned age group was conducted at the VCT sites of MMSH, IDH and HBPH. Simple/rapid testing method was employed in the research and conducted in accordance with WHO’s recommended assays. Out of the 317 children counseled, only 276 (87%) decided to be tested for HIV. Results obtained from the work show that 4% of the tested children were positive. The prevalence of HIV with respect to sex and age of the subject involved in this study was higher in males and 1.5 – 5.0 years age group respectively.
Challenges in the Management of HIV-Infected Malnourished Children in Sub-Saharan Africa  [PDF]
Indi Trehan,Bernadette A. O'Hare,Ajib Phiri,Geert Tom Heikens
AIDS Research and Treatment , 2012, DOI: 10.1155/2012/790786
Abstract: Infection with HIV, and oftentimes coinfection with TB, complicates the care of severely malnourished children in sub-Saharan Africa. These superimposed infections challenge clinicians faced with a population of malnourished children for whose care evidence-based guidelines have not kept up. Even as the care of HIV-uninfected malnourished children has improved dramatically with the advent of community-based care and even as there are hopeful signs that the HIV epidemic may be stabilizing or ameliorating, significant gaps remain in the care of malnourished children with HIV. Here we summarize what is currently known, what remains unknown, and what remains challenging about how to treat severely malnourished children with HIV and TB. 1. Background An estimated 19 million children are severely wasted in developing countries—malnutrition is responsible for 11% of the total global disease burden and 35% of child deaths worldwide [1]. In some regions, notably sub-Saharan Africa, human immunodeficiency virus (HIV) infection poses an added challenge to the care of malnourished children. While the clinical context and interventions for many common causes of childhood mortality worldwide have been addressed over the last decade [2], the management of severe wasting disease and malnutrition in children—particularly in those infected with HIV and/or tuberculosis (TB)—remains poorly addressed [3]. This population of HIV- and TB-infected malnourished children is in many ways very different from the uninfected population for which international malnutrition guidelines [4–6] were originally developed. In sub-Saharan Africa, the epidemiology of severe malnutrition has shifted to one where an increasing percentage of children requiring hospitalization is composed of those who are HIV infected or HIV exposed—often coinfected with TB—with case-fatality rates still as high as 20–50% [7]. Meanwhile, ready-to-use therapeutic foods (RUTFs) that facilitate effective home-based therapy have resulted in recovery rates for uncomplicated severe malnutrition approaching 90% [8–10], although the recovery rates remain much lower for those children with HIV [11]. In this paper, we present some of the challenges and unanswered questions in the management of malnourished children with HIV (and often TB) and summarize our approach to managing these problems in the absence of clear data to guide us. 2. The Magnitude of the Problem The average estimated HIV prevalence in 2009 for African adults between the ages of 15 and 49 is about 4.7% [12], with a range from 0.1% to 26% depending on the
Oral manifestations of HIV/AIDS infection in Nigerian patients seen in Kano
JT Arotiba, RA Adebola, Z Iliyasu, M Babashani, WA Shokunbi, MMA Ladipo, BI Akhiwu, OD Osude
Nigerian Journal of Surgical Research , 2005,
Abstract: Objective: To determine the pattern and prevalence of oral lesions in HIV-infected Nigerian patients seen in a referral centre. Design: Prospective hospital based study. Setting: Aminu Kano Teaching Hospital, Kano-a tertiary health institution servicing the entire north-western Nigeria. Subjects: 205 HIV infected individuals who consented to participate in the study. Method: All patients were interviewed and examined by at least two Dental Surgeons trained in diagnosis of oral manifestations of HIV. Data were captured on adapted WHO recording form for oral lesions associated with HIV, transferred and analyzed using MINITAB12.21 (U.S.A). Results: The age range was18-61 years (mean=33.7, S.D =8.0).The M: F =1.2:1; There was statistically significant difference (t=8.1, DF=201, P-value = 0.001) between mean age for males (37.3; S.D.=7.8years) and females (29.5; SD=5.9 years). Overall, 140 (68.3%) patients had at least one oral lesion. Most common lesion was candidosis (60.5%) and the pseudomembranous (45.4%) type was most frequent. Other lesions were HIV gingivitis (27.8%), hairy leukoplakia (14.2%), aphthous ulcer (9.8%), Kaposi's sarcoma (8.3%), melanin hyper-pigmentations (7.3%), herpes simplex infection (5.4%), HIV periodontitis (4.9%), parotid enlargement (1.9%) and HIV-NOMA (0.5%). The mean CD4 counts were 301, 268 and 289 for those without oral lesion, with single lesion and multiple oral lesions respectively. These differences were not statistically significant (ANOVA F=0.36 DF=2 P=0.7). Conclusion: Oral lesions are frequently seen in HIV-infected Nigerian patients and the pattern of occurrence is not markedly different from those reported from other African countries. Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 176-181
The impact of HIV infection on the clinical presentation of severe malnutrition in children at QECH
L Kessler, H Daley, G Malenga, SM Graham
Malawi Medical Journal , 2001,
Abstract: A study was undertaken in a central nutritional rehabilitation unit (NRU) in southern Malawi to assess the impact of HIV infection on clinical presentation and case fatality rate. The HIV seroprevalence for 250 severely malnourished children over 1 year of age was 34.4% and the overall mortality was 28%. HIV infection was significantly more associated with marasmus (62.2%) than with kwashiorkor (21.7%) [p<0.0001]. Clinical and radiological features were not helpful in distinguishing HIV infected from non HIV infected children. The in-hospital case fatality rate was significantly higher for HIV infected children (38.4%) compared to severely malnourished children without HIV infection (22.7%) [p<0.05]. Though HIV infection contributes to the high mortality experienced in NRU's in Malawi, we argue that more remediable contributing factors still need to be addressed. Malawi Medical Journal Vol 13, No.3 (Sept 2001): pp30-33
Measles in children with HIV infection: report of five cases
Carvalho, Vania de;Marinoni, Leide Parolin;Martins, Luzilma Flenick;Taniguchi, Kerstin;Cruz, Cristina Rodrigues da;Bertogna, Jeanine;Fillus Neto, José;
Brazilian Journal of Infectious Diseases , 2003, DOI: 10.1590/S1413-86702003000500010
Abstract: patients with aids have a high incidence of skin problems due to the immunosuppression and malnourishment that are inherent to the progression of this disease. clinical manifestation of these skin lesions and their severity are different in aids patients. we made a prospective study of five cases of measles in children with hiv infection during a community outbreak, and there were typical as well as atypical forms of the disease, including one case with negative serology. there were pulmonary complications, but none of the patients died. the anti-retroviral treatment may have contributed to the decrease in measles morbidity in these pediatric aids patients.
Measles in children with HIV infection: report of five cases  [cached]
Carvalho Vania de,Marinoni Leide Parolin,Martins Luzilma Flenick,Taniguchi Kerstin
Brazilian Journal of Infectious Diseases , 2003,
Abstract: Patients with AIDS have a high incidence of skin problems due to the immunosuppression and malnourishment that are inherent to the progression of this disease. Clinical manifestation of these skin lesions and their severity are different in AIDS patients. We made a prospective study of five cases of measles in children with HIV infection during a community outbreak, and there were typical as well as atypical forms of the disease, including one case with negative serology. There were pulmonary complications, but none of the patients died. The anti-retroviral treatment may have contributed to the decrease in measles morbidity in these pediatric AIDS patients.
Effects of HIV Infection on the Metabolic and Hormonal Status of Children with Severe Acute Malnutrition  [PDF]
Aaloke Mody, Sarah Bartz, Christoph P. Hornik, Tonny Kiyimba, James Bain, Michael Muehlbauer, Elizabeth Kiboneka, Robert Stevens, John V. St. Peter, Christopher B. Newgard, John Bartlett, Michael Freemark
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0102233
Abstract: Background HIV infection occurs in 30% of children with severe acute malnutrition in sub-Saharan Africa. Effects of HIV on the pathophysiology and recovery from malnutrition are poorly understood. Methods We conducted a prospective cohort study of 75 severely malnourished Ugandan children. HIV status/CD4 counts were assessed at baseline; auxologic data and blood samples were obtained at admission and after 14 days of inpatient treatment. We utilized metabolomic profiling to characterize effects of HIV infection on metabolic status and subsequent responses to nutritional therapy. Findings At admission, patients (mean age 16.3 mo) had growth failure (mean W/H z-score ?4.27 in non-edematous patients) that improved with formula feeding (mean increase 1.00). 24% (18/75) were HIV-infected. Nine children died within the first 14 days of hospitalization; mortality was higher for HIV-infected patients (33% v. 5%, OR = 8.83). HIV-infected and HIV-negative children presented with elevated NEFA, ketones, and even-numbered acylcarnitines and reductions in albumin and amino acids. Leptin, adiponectin, insulin, and IGF-1 levels were low while growth hormone, cortisol, and ghrelin levels were high. At baseline, HIV-infected patients had higher triglycerides, ketones, and even-chain acylcarnitines and lower leptin and adiponectin levels than HIV-negative patients. Leptin levels rose in all patients following nutritional intervention, but adiponectin levels remained depressed in HIV-infected children. Baseline hypoleptinemia and hypoadiponectinemia were associated with increased mortality. Conclusions Our findings suggest a critical interplay between HIV infection and adipose tissue storage and function in the adaptation to malnutrition. Hypoleptinemia and hypoadiponectinemia may contribute to high mortality rates among malnourished, HIV-infected children.
Impact of HIV/AIDS on mortality and nutritional recovery among hospitalized severely malnourished children before starting antiretroviral treatment  [PDF]
Léon G. Blaise Savadogo, Philippe Donnen, Fla Kouéta, Eléonore Kafando, Philippe Hennart, Michèle Dramaix
Open Journal of Pediatrics (OJPed) , 2013, DOI: 10.4236/ojped.2013.34061

In low income countries, severe acute malnutrition remains a major problem for HIV-infected children and an important risk factor for mortality. This study aims to analyze HIV impact on mortality rate and nutritional recovery among severely malnourished HIV/AIDS uninfected and infected children. This was a retrospective cohort study conducted from data of 521 hospitalized severely malnourished children. We used Pearson’s Chi square test to compare proportions; and Student’s independent t-test to compare means; general linear model to analyze repeated measurements. We used mortality relative risk with confidence interval (CI 95%), Kaplan-Meir survival curves and Cox proportional hazard models to analyze the HIV impact on mortality rate. Case fatality rate differed significantly from SAM HIV uninfected (10.7%) and HIV infected children (39.7%), p < 0.001. Mortality relative risk was 3.71, 95% IC [2.51 - 5.47] for HIV infected children. Kaplan-Meir survival curves differed significantly between the two groups, (p Log Rank < 0.001). Cox regression adjusted mortality relative risk of HIV infected children was 4.27, CI: 2.55 - 7.15, p < 0.001. Mean weight gain differed significantly among infected children, p < 0.001. Anthropometric Z-scores means evolution differed significantly between HIV infected and uninfected children and within each group’s subjects for WHZ (p < 0.001) and WAZ (p < 0.001). Mortality relative risk was 3.71 times higher for HIV infected children. Multiples infections and metabolic complications have synergism on death occurrence in sever acute malnutrition; when associated to HIV infection, case fatality rate increases many times. Weight gain and anthropometrics index evolution were very slow for SAM HIV infected children, and specific diet may be needed for more nutritional recovery. Effective interventions, updated and adapting to local country context, to improve survival of severely malnourished HIV/AIDS infected children in HIV and SAM prevalent settings are urgently needed in the area of SAM’s community-based treatment approach.

Should the routine approach to diarrhoea management be modified in an area of high prevalence of paediatric HIV infection?
AJ Terblanche, R Netshimboni, DF Wittenberg
South African Journal of Child Health , 2012,
Abstract: Background. Unthinking application of the routine diarrhoea management protocol in patients presenting with diarrhoea could risk possible co-morbidities such as HIV infection being ignored in an environment with a high prevalence of HIV infection. Furthermore, a patterned response to testing for HIV infection only those children in whom it is suspected on clinical grounds will lead to missed opportunities for HIV care. Aims and methods. This was a retrospective review of patients admitted to Kalafong and Steve Biko referral hospitals to identify the impact of a high prevalence of HIV infection in the community on the routine management of diarrhoea. Results. A total of 176 patients were included. HIV tests were performed on 99 patients, and HIV infection was therefore not considered as a co-diagnosis in 78 of 176 (44.3%) of patients with diarrhoea. On admission, the group of children tested for HIV infection were similar to the other groups (not tested for HIV or HIV negative) in age, but showed differences in respect of duration of diarrhoea and preceding events prior to referral. More children tested for HIV infection also had clinical wasting, generalised lymphadenopathy or hepatomegaly compared with untested children (p<0.005). However, there were no differences in the proportion of tested children with prior antibiotics before referral, presence of co-morbid pneumonia or urinary infection. Patients with diarrhoea were more likely to be tested for HIV if they were severely malnourished or clinically wasted, if they had hyponatraemia or hypokalaemia, and if they had hepatomegaly or lymphadenopathy. The presence of shock or severe dehydration on admission, or of comorbid pneumonia, did not differentiate between those who were tested for HIV and those who were not. There were statistically significant differences between those tested for HIV and those not tested in respect of outcome. Among the children tested for HIV, 24.2% of survivors had a prolonged hospital stay (more than 10 days), compared with 1.4% among those not tested (p<0.005). While more children in the group tested for HIV died in hospital (6.1% v. 2.6%), this did not reach statistical significance (p=0.466). Conclusion. In this study, HIV testing was found to be predominantly based on clinical grounds at the time of admission. Because of considerable clinical overlap between diarrhoea patients with and without HIV infection, HIV co-infection cannot be reliably predicted on clinical features alone and must be actively excluded.
HIV prevalence in severely malnourished children admitted to nutrition rehabilitation units in Malawi: Geographical & seasonal variations a cross-sectional study
Susan Thurstans, Marko Kerac, Kenneth Maleta, Theresa Banda, Anne Nesbitt
BMC Pediatrics , 2008, DOI: 10.1186/1471-2431-8-22
Abstract: A cross sectional survey was conducted in 12 representative rural and urban Nutrition Rehabilitation Units (NRUs), from each of Malawi's 3 regions.All children and their caretakers admitted to each NRU over a two week period were offered HIV counselling and testing. Testing was carried out using two different rapid antibody tests, with PCR testing for discordant results. Children under 15 months were excluded, to avoid difficulties with interpretation of false positive rapid test results.The survey was conducted once in the dry/post-harvest season, and repeated in the rainy/hungry season.570 children were eligible for study inclusion. Acceptability and uptake of HIV testing was high: 523(91.7%) of carers consented for their children to take part; 368(70.6%) themselves accepted testing.Overall HIV prevalence amongst children tested was 21.6%(95% confidence intervals, 18.2–25.5%). There was wide variation between individual NRUs: 2.0–50.0%.Geographical prevalence variations were significant between the three regions (p < 0.01) with the highest prevalence being in the south: Northern Region 23.1%(95%CI 14.3–34.0%), Central Region 10.9%(95%CI 7.5–15.3%), and Southern Region 36.9%(95%CI 14.3–34.0%).HIV prevalence was significantly higher in urban areas, 32.9%(95%CI 26.8–39.4%) than in rural 13.2%(95%CI 9.5–17.6%)(p < 0.01).NRU HIV prevalence rates were lower in the rainy/hungry season 18.4%(95%CI 14.7–22.7%) than in the dry/post-harvest season 30.9%(95%CI 23.2–39.4%) (p < 0.001%).There is a high prevalence of HIV infection in severely malnourished Malawian children attending NRUs with children in urban areas most likely to be infected. Testing for HIV is accepted by their carers in both urban and rural areas. NRUs could act as entry points to HIV treatment and support programmes for affected children and families. Recognition of wide geographical variations in childhood HIV prevalence will ensure that limited resources are initially targeted to areas of highest need.Thes
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