DISEASE IN CHILDREN INFECTED WITH HIV IN ABIDJAN, COTE-DIVOIRE

Objective-To document the range of disease in African children infecte d with HIV. Design-Necropsy results in consecutive children aged 1 mon th or more who were HIV positive and in children who were HIV negative for comparison; IgA western blots on serum samples from children unde r 2 years of age who were positive for HIV-1 to test the validity of r outine HIV serology. Setting-Largest hospital in Abidjan, Cote d'Ivoir e. Subjects-78 children who were HIV positive and 77 children who were HIV negative on whom a necropsy was performed; their median ages at d eath were 18 and 21 months respectively. 36 HIV positive children and 29 HIV negative children mere 1-14 months old; 42 HIV positive and 48 HIV negative children were greater than or equal to 15 months old. Mai n outcome measures-Cause of death and prevalence of diseases confirmed pathologically. Results-Respiratory tract infections were more common in HIV positive than in HIV negative children (73 (94%) v 52 (68%); P <0.05), and were aetiologically heterogeneous. Pneumocystis carinii pn eumonia was found in 11 out of 36 (31%) HIV positive children aged <15 months, but in no HIV negative children. Among older children measles was more common in HIV positive children (8/42 (19%) v 2/48 (4%); P < 0.06). Pyogenic meningitis was present in similar proportions of HIV positive and HIV negative children aged < 15 months (7/36 (19%) and 7/ 29 (24%)). In HIV positive children tuberculosis (1/78), lymphocytic i nterstitial pneumonitis (1/78), and HIV encephalitis (2/78) were rare. Conclusions-There is greater overlap between diseases associated with HIV infection and other common health problems in African children th an there is in adults. Compared with adults, HIV positive children had a high prevalence of P carinii pneumonia and a low prevalence of tube rculosis. Measles, but not malaria, was associated with HIV infection.