Patterns of presentation of human immunodeficiency virus type 1-infected children to the paediatric surgeon

PURPOSE/METHODS: Review of the records of infants and children admitted with human immunodeficiency virus type 1 (HIV-1) infection was undertaken to determine the mode and pattern of presentation at the Paediatric Surgical Unit, King Edward VIII Hospital, Durban. RESULTS: Over the 2-year period-December 1994 to December 1996-63 patients with recognised HIV infection presented to the surgical unit. Seventeen were known to have acquired immunodeficiency syndrome (AIDS). Infection was the most common presenting problem (n = 37). In this group, 14 had abscesses, cellulitis, or osteitis. 18 had perineal sepsis-11 had acquired rectovaginal fistulae, two had fistulae-in-ano, one a perianal abscess, two had perineal condylomata, and two had rape-related injuries and sepsis. Three children presented with overwhelming sepsis, one neonate presented with haemorrhagic colitis caused by cytomegalovirus, and one older child presented with oesophageal candidiasis. Generalised lymphadenopathy was the presenting complaint in 14 children. Biopsy results showed nonspecific reactive changes in six children, HIV-reactive changes in five, and tuberculosis in three patients. Ten children presented with non-HIV-related problems; nine were neonates with congenital anomalies. An older child presented with a coin impacted in his oesophagus. Two children presented with tumours-one had a Kaposi sarcoma and one had a Wilms' tumour. CONCLUSIONS: Twenty-six percent had clinical manifestation of AIDS, 19% presented with lesions diagnostic of HIV infection, 22% presented with signs or symptoms that were suggestive of the disease, and 33% were asymptomatic of HIV infection.