Clinical Staging of HIV Infection as a Surrogate for CD4 Count in HIV-Infected Children

Abstract

BACKGROUND: Human immunodeficiency virus (HIV)
infection is a major cause of infant and childhood mortality and
morbidity; without treatment about 50% of them will succumb
to HIV/AIDS before the age of two years.
OBJECTIVE: To evaluate the usefulness of clinical
manifestations of HIV infection as a surrogate for CD4 counts
in antiretroviral-naive HIV-infected children.
METHODS: Newly diagnosed HIV-infected children,
antiretroviral-naïve attending a paediatric infectious diseases
unit were enrolled. The clinical manifesta-tions, age, sex, and
WHO clinical stage of each patient were determined. CD4 count
and CD4% were estimated at presentation and correlated with
various clinical manifestations of HIV disease.
RESULTS: The study population consisted of 126 children, aged
four months to 14 years with a mean of 3.2 ± 2.7 years and a
male to female ratio of 1.2:1. Eighty-one percent of the children
acquired HIV infection through mother-to-child transmission
(MTCT). The CD4% was higher in infants (p<0.000) and lower
in children over five years of age. Eighty-six percent of them in
stage 4 were children less than 24 months of age. CD4% showed
a modest correlation with WHO paediatric clinical staging
(r=0.62, p=0.002). Patients with lymphadenopathy (stage 1) had
a high absolute CD4 count whereas patients with failure to
thrive had a relatively low absolute CD4 count.
CONCLUSION: WHO Paediatric clinical staging for HIV
infection correlates with CD4% and can be used as a surrogate
to CD4. CD4 count and CD4% vary with age and complications
of the disease.