Age related clinical manifestations of HIV infection in Indian children

AIM: To determine the various clinical manifestations of HIV infection in children as per the age. SETTING: Pediatric and Perinatal HIV clinic in a tertiary pediatric hospital over a period of 7 years.Study design: Retrospective and prospective analysis. METHODS AND MATERIALS: Clinical manifestations of 317 HIV infected children were noted and commonest clinical symptoms were determined. The various clinical manifestations as per age were analysed. RESULTS: The mean age of presentation of HIV infection was 4.5+/-2.9 years. Predominant mode of transmission was vertical (83 per cent). Most of the children (75 per cent) were in Class B or C on presentation. There was no significant difference in the clinical symptoms and mode of transmission of HIV. The predominant clinical features seen were hepato-splenomegaly (51.1 per cent), lymphadenopathy (48.6 per cent) and tuberculosis (43.4 per cent). Patients with vertical transmission presented at an early mean age of 4.1+/-2.7 years as compared to those who acquired it by other means, which was statistically significant. PCP pneumonia was the earliest manifestation in toddlers and hepatosplenomegaly, lymphadenopathy, chronic diarrhea was seen in pre-schoolers. Systemic organ dysfunction due to HIV was seen in older children. CONCLUSIONS: Hepatosplenomegaly, lymphadenopathy and opportunistic infections together in a child may be suggestive of HIV infection. High suspicion and early diagnosis will lead to early management and decrease in the incidence of HIV related morbidity.