Utility of clinical parameters to identify HIV infection in infants below ten weeks of age in South Africa: a prospective cohort study

 

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dc.contributor.author Jaspan, Heather en_ZA
dc.contributor.author Myer, Landon en_ZA
dc.contributor.author Madhi, Shabir en_ZA
dc.contributor.author Violari, Avy en_ZA
dc.contributor.author Gibb, Diana en_ZA
dc.contributor.author Stevens, Wendy en_ZA
dc.contributor.author Dobbels, Els en_ZA
dc.contributor.author Cotton, Mark en_ZA
dc.date.accessioned 2015-10-28T07:08:18Z
dc.date.available 2015-10-28T07:08:18Z
dc.date.issued 2011 en_ZA
dc.identifier.citation Jaspan, H. B., Myer, L., Madhi, S. A., Violari, A., Gibb, D. M., Stevens, W. S., ... & Cotton, M. F. (2011). Utility of clinical parameters to identify HIV infection in infants below ten weeks of age in South Africa: a prospective cohort study. BMC pediatrics, 11(1), 104. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/14479
dc.identifier.uri http://dx.doi.org/10.1186/1471-2431-11-104
dc.description.abstract BACKGROUND:As HIV-infected infants have high mortality, the World Health Organization now recommends initiating antiretroviral therapy as early as possible in the first year of life. However, in many settings, laboratory diagnosis of HIV in infants is not readily available. We aimed to develop a clinical algorithm for HIV presumptive diagnosis in infants < 10 weeks old using screening data from the Children with HIV Early Antiretroviral therapy (CHER) study in South Africa.HIV-infected and HIV-uninfected exposed infants < 10 weeks of age were identified through Vertical Transmission Prevention programs. Clinical and laboratory data were systematically recorded, groups were compared using Kruskal-Wallis, analysis of variance (ANOVA), and Fisher's exact tests. Receiver Operating Characteristic (ROC) curves were compiled using combinations of clinical findings. RESULTS: 417 HIV-infected and 125 HIV-exposed, uninfected infants, median age 46 days (IQR 38-55), were included. The median CD4 percentage in HIV-infected infants was 34 (IQR 28-41)%. HIV-infected infants had lower weight-for-age, more lymphadenopathy, oral thrush, and hepatomegaly than exposed uninfected infants (Adjusted Odds Ratio 0.51, 8.8, 5.6 and 23.5 respectively; p < 0.001 for all). Sensitivity of individual signs was low (< 20%) but specificity high (98-100%). If any one of oral thrush, hepatomegaly, splenomegaly, lymphadenopathy, diaper dermatitis, weight < 50th centile are present, sensitivity for HIV infection amongst HIV-exposed infants was 86%. These algorithms performed similarly when used to predict severe immune suppression. CONCLUSIONS: A combination of physical findings is helpful in identifying infants most likely to be HIV-infected. This may inform management algorithms and provide guidance for focused laboratory testing in some settings, and should be further validated in these settings and elsewhere. en_ZA
dc.language.iso eng en_ZA
dc.publisher BioMed Central Ltd en_ZA
dc.rights This is an Open Access article distributed under the terms of the Creative Commons Attribution License en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/2.0 en_ZA
dc.source BMC Pediatrics en_ZA
dc.source.uri http://www.biomedcentral.com/bmcpediatr/ en_ZA
dc.subject.other HIV Infections en_ZA
dc.subject.other Infants en_ZA
dc.subject.other Polymerase Chain Reaction en_ZA
dc.subject.other Prospective Studies en_ZA
dc.subject.other Risk Factors en_ZA
dc.title Utility of clinical parameters to identify HIV infection in infants below ten weeks of age in South Africa: a prospective cohort study en_ZA
dc.type Journal Article en_ZA
dc.rights.holder 2011 Jaspan et al; licensee BioMed Central Ltd. en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Department of Paediatrics and Child Health en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Jaspan, H., Myer, L., Madhi, S., Violari, A., Gibb, D., Stevens, W., ... Cotton, M. (2011). Utility of clinical parameters to identify HIV infection in infants below ten weeks of age in South Africa: a prospective cohort study. <i>BMC Pediatrics</i>, http://hdl.handle.net/11427/14479 en_ZA
dc.identifier.chicagocitation Jaspan, Heather, Landon Myer, Shabir Madhi, Avy Violari, Diana Gibb, Wendy Stevens, Els Dobbels, and Mark Cotton "Utility of clinical parameters to identify HIV infection in infants below ten weeks of age in South Africa: a prospective cohort study." <i>BMC Pediatrics</i> (2011) http://hdl.handle.net/11427/14479 en_ZA
dc.identifier.vancouvercitation Jaspan H, Myer L, Madhi S, Violari A, Gibb D, Stevens W, et al. Utility of clinical parameters to identify HIV infection in infants below ten weeks of age in South Africa: a prospective cohort study. BMC Pediatrics. 2011; http://hdl.handle.net/11427/14479. en_ZA
dc.identifier.ris TY - Journal Article AU - Jaspan, Heather AU - Myer, Landon AU - Madhi, Shabir AU - Violari, Avy AU - Gibb, Diana AU - Stevens, Wendy AU - Dobbels, Els AU - Cotton, Mark AB - BACKGROUND:As HIV-infected infants have high mortality, the World Health Organization now recommends initiating antiretroviral therapy as early as possible in the first year of life. However, in many settings, laboratory diagnosis of HIV in infants is not readily available. We aimed to develop a clinical algorithm for HIV presumptive diagnosis in infants < 10 weeks old using screening data from the Children with HIV Early Antiretroviral therapy (CHER) study in South Africa.HIV-infected and HIV-uninfected exposed infants < 10 weeks of age were identified through Vertical Transmission Prevention programs. Clinical and laboratory data were systematically recorded, groups were compared using Kruskal-Wallis, analysis of variance (ANOVA), and Fisher's exact tests. Receiver Operating Characteristic (ROC) curves were compiled using combinations of clinical findings. RESULTS: 417 HIV-infected and 125 HIV-exposed, uninfected infants, median age 46 days (IQR 38-55), were included. The median CD4 percentage in HIV-infected infants was 34 (IQR 28-41)%. HIV-infected infants had lower weight-for-age, more lymphadenopathy, oral thrush, and hepatomegaly than exposed uninfected infants (Adjusted Odds Ratio 0.51, 8.8, 5.6 and 23.5 respectively; p < 0.001 for all). Sensitivity of individual signs was low (< 20%) but specificity high (98-100%). If any one of oral thrush, hepatomegaly, splenomegaly, lymphadenopathy, diaper dermatitis, weight < 50th centile are present, sensitivity for HIV infection amongst HIV-exposed infants was 86%. These algorithms performed similarly when used to predict severe immune suppression. CONCLUSIONS: A combination of physical findings is helpful in identifying infants most likely to be HIV-infected. This may inform management algorithms and provide guidance for focused laboratory testing in some settings, and should be further validated in these settings and elsewhere. DA - 2011 DB - OpenUCT DO - 10.1186/1471-2431-11-104 DP - University of Cape Town J1 - BMC Pediatrics LK - https://open.uct.ac.za PB - University of Cape Town PY - 2011 T1 - Utility of clinical parameters to identify HIV infection in infants below ten weeks of age in South Africa: a prospective cohort study TI - Utility of clinical parameters to identify HIV infection in infants below ten weeks of age in South Africa: a prospective cohort study UR - http://hdl.handle.net/11427/14479 ER - en_ZA


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