Epidemiologic and clinical features of HIV-infected and HIV-uninfected Ugandan children younger than 18 months

Methods: Groups of HIV-infected and HIV-uninfected infants younger than 18 months (mainly younger than 6 months) were compared to identify clinical fe atures that could differentiate the two groups, The HIV-infected group also was compared with HIV-infected children older than 18 months. Recruitment was as follows for the group younger than 18 months: 708 children admitted with sepsis and clinical features suggestive of HIV infection were screened for HIV1 and HIV2 by HIV enzyme-linked immunosorbent assay ELISA), and pol ymerase chain reaction (PCR) was undertaken on all ELISA-seropositive blood samples (270). HIV infection was confirmed in 136 (19.2%), 438 (61.9%) wer e HIV-seronegative, 27 (3.8%) were HIV seroreverters, 36 (5.1%) were HIV-se ropositive but PCR negative (uninfected), and 71 (10.0%) were indeterminate . One hundred thirty-six HIV-infected children were compared with 501 uninf ected children. Confirmed HIV-infected children older than 18 months attend ing the pediatric HIV clinic were compared with the 136 HIV-infected childr en younger than 18 months. Results: Under 18 months, the median age of HIV-infected children (n = 136) was 4.0 months (range, 3 d-18 mo) and the median age of the uninfected chi ldren (n = 501) was 1.0 month (range, 3 d-18 mo). HIV-infected children wer e more likely to have had injections, chloroquine, and nystatin, and to hav e attended a health center or hospital (p < .001). In the HIV-infected grou p, the Z score for weight-for-age was -1.75, length-for-age -0.78, and weig ht-for-length 1.86, significantly lower scores than those of the uninfected group, which were -0.60, -0.23, and 3.05, respectively (p < .05). The mean head circumference was below the third percentile in 40% of HIV-infected c ompared with 22% of uninfected children (p < .001). Overall, 56 (8%) childr en had marasmus, 6 (0.8%) kwashiorkor, and 3 (0.4%) marasmic kwashiorkor. S ixteen percent of the HIV-infected and 7% of uninfected children had marasm us (p < .05). The 1989 revised World Health Organization clinical criteria for diagnosis of AIDS had sensitivity, specificity, and positive predictive values of 28%, 98%, and 93%, respectively. Older than 18 months (n = 109), the median age was 24 months (range, 18-60 mo). The following were signifi cantly more common in HIV-infected children older than 18 months than in th ose younger than 18 months: bacille Calmette-Guerin vaccination sear, parot id enlargement, nonspecific generalized dermatitis, and chronic diarrhea (p < .001). Oral candidiasis was more common in the group younger than 18 mon ths (p < .001). In infants examined in the hospital for infective condition s, oropharyngeal candidiasis, ear discharge, dermatologic disorders, genera lized lymphadenopathy, lobar consolidation, hepatosplenomegaly, and failure to thrive, especially marasmus, were important indicators of HIV infection .