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.authorJaspan, Heatheren_ZA
dc.contributor.authorMyer, Landonen_ZA
dc.contributor.authorMadhi, Shabiren_ZA
dc.contributor.authorViolari, Avyen_ZA
dc.contributor.authorGibb, Dianaen_ZA
dc.contributor.authorStevens, Wendyen_ZA
dc.contributor.authorDobbels, Elsen_ZA
dc.contributor.authorCotton, Marken_ZA
dc.date.accessioned2015-10-28T07:08:18Z
dc.date.available2015-10-28T07:08:18Z
dc.date.issued2011en_ZA
dc.description.abstractBACKGROUND: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.identifier.apacitationJaspan, 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/11427/14479en_ZA
dc.identifier.chicagocitationJaspan, 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/11427/14479en_ZA
dc.identifier.citationJaspan, 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.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
dc.identifier.urihttp://hdl.handle.net/11427/14479
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2431-11-104
dc.identifier.vancouvercitationJaspan 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.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDepartment of Paediatrics and Child Healthen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2011 Jaspan et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Pediatricsen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcpediatr/en_ZA
dc.subject.otherHIV Infectionsen_ZA
dc.subject.otherInfantsen_ZA
dc.subject.otherPolymerase Chain Reactionen_ZA
dc.subject.otherProspective Studiesen_ZA
dc.subject.otherRisk Factorsen_ZA
dc.titleUtility of clinical parameters to identify HIV infection in infants below ten weeks of age in South Africa: a prospective cohort studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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