Usefulness of acute phase reactants in the diagnosis of acute infections in HIV-infected children

Background. Children infected with the human immunodeficiency virus (HIV) o ften have hypergammaglobulinemia, causing elevation of the erythrocyte sedi mentation rate (ESR). This study was done to determine whether C-reactive p rotein (CRP) is a better indicator of acute infection than ESR in HIV-infec ted children. Methods. Erythrocyte sedimentation rate, CRP, and immunoglobulin G (IgG) le vels were measured in sick and otherwise healthy HIV-infected children. McN emar's test was used to compare ESR and CRP. Results. In 22 of the 26 cases (85%), the IgG level was elevated, and in al l cases ESR was elevated. In 20 of these 22 (91%), both ESR and CRP were el evated. Of the 18 controls, 17 (94%) had elevated IgG, 14 of 17 (82%) had e levated ESR, and 1 (7%) had elevated CRP. The sensitivity for ESR and CRP w as 96% and 92%, respectively, and the specificity for ESR and CRP was 17% a nd 94%, respectively. Conclusions. Since CRP is more specific than ESR in predicting acute infect ion in HIV-infected children, it should he used in the evaluation of acute infection in this population.