Prevalence of HIV type 1 infection, associated clinical features and mortality among hospitalized children in Dar es Salaam, Tanzania

The aim of this study was to determine the prevalence of HIV-1 infection, t he clinical spectrum of HIV-l-associated conditions and HIV-1-associated mo rtality among children hospitalized in the medical paediatric wards at Muhi mbili Medical Centre (MMC), Dar es Salaam, Tanzania. All children admitted to the medical paediatric wards of MMC between August 1995 and January 1996 were eligible for the study. Testing for HIV antibodies was done using 2 c onsecutive enzyme linked inmunosorbent assays (ELISAs). ELISA-reactive samp les from children aged 18 months and below were further tested by a recentl y developed heat-denatured p24 antigen assay. The prevalence of HIV-1 infec tion among the 2015 children studied was 19.2%. When present for 14 days or more, fever, cough, diarrhoea, ear discharge, oral ulcers and skin rash we re all significantly more common in HIV-1-infected than in HIV-uninfected c hildren (p < 0.001). In the multivariate analysis cough, ear discharge, oro pharyngeal ulcers and skin rash were found to be the most important symptom s. Clinical signs found to be significantly associated with HIV-1 infection in the univariate analysis were wasting, stunting, hair changes, oral thru sh, oropharyngeal ulcers, lymphadenopathy, lung consolidation and lung crep itations (p < 0.001). In the multivariate analysis, oral thrush, lung crepi tations, cervical lymphadenopathy, wasting and inguinal lymphadenopathy wer e found to be the most important signs. The 3 most common diagnoses in HIV- 1-infected children were acute respiratory infection (ARI) (39.4%), malnutr ition (38.1%) and tuberculosis (19.3%), while in HIV-uninfected children th ey. were malaria (47.0%), ARI (25.0%) and malnutrition (16.1%). The mortali ty rate was 21.4% in HIV-1-infected children and 8.4% in HIV-uninfected chi ldren (p < 0.001). In conclusion, the prevalence of HIV-1 infection among h ospitalized children at the main hospital in Dar es Salaam was high and ass ociated with high mortality. Many symptoms and signs are indicative of HIV- 1 infection, but appropriate laboratory testing is required for diagnosis.