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Observational study on EFFECT OF HIV INFECTION ON PRESENTATION AND OUTCOME OF diarrhoeal diseases in children less than 5 years of age in Kwazulu-Natal, South Africa
  1. M Saito-Benz1,
  2. K Lundeby2
  1. 1Neonatal Intensive Care, Portsmouth Hospitals Trust, Portsmouth, UK
  2. 2Paediatrics, Ngwelezane Hospital, Kwazulu-Natal, South Africa

Abstract

Objectives Primary objective was to compare mortality directly attributed to diarrhoeal diseases in HIV-infected, HIV-exposed but uninfected, and HIV-unexposed children between 2 months and 5 years of age. Secondary objectives were to compare presence of co-morbidities, parameters indicative of severe diarrhoea at presentation and outcome parameters.

Methods Intramuscular Triamcinolone for Difficult Asthma Prospective observational study using medical records. 120 children in the appropriate age group were admitted as non-referral cases to Ngwelezane hospital with diarrhoeal diseases between 1st March and 30th June 2011. Children who received traditional remedies prior to admission were excluded (n=28). For 4 children medical records were untraceable. HIV status is confirmed by viral RNA Polymerase Chain Reaction in children younger than 18 months, and either 2 positive rapid tests (different brands) or one positive rapid and one positive ELISA in children older than 18 months. HIV-exposed is confirmed mainly by mother's Prevention of Mother To Child Transmission status. If this is not available, mother's Voluntary Counselling Test result at the time of admission is used.

Survival analysis and cox regression test were performed on the primary objective.

Results Of 88 children, 25 are HIV-positive (28%), 25 HIV-exposed but uninfected (28%) and 38 HIV-unexposed (44%). Mortality directly attributed to diarrhoeal diseases was 6/25 (24%, p=0.08), 4/25 (16%, p=0.19), 2/38 (5%) respectively. Average durations of inpatient-stay are 22, 15 and 12 days respectively. With the exception of presence of dysentery and renal impairment, parameters indicative of severe diarrhoea (severity of dehydration and arterial blood gas results) are similar in all 3 groups. For HIV-positive children, average CD4 count is 462, CD4% 15.5 and viral load 1772720.

Conclusions Although not statistically significant at 95% CI, mortality due to diarrhoeal diseases appear higher in HIV-positive children and it occurs more frequently in the first 5 days of admission. This should alert clinicians that HIV-positive children with diarrhoeal diseases require more intensive monitoring and treatment even if their initial presentations are similar to HIV-unexposed children.

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