1. Logo Methods Introduction Results
CIPP XVI
LISBON PORTUGAL
G1-4
PREVALENCE AND PATTERN OF RESPIRATORY DISEASES IN CHILDREN LIVING WITH HIV IN ENUGU, SOUTH-EAST, NIGERIA
Ayuk Adaeze C1 Ubesie Agozie C 1 Iloh Kenechukwu K 1 Obumneme-Anyim N Ijeoma N1 Emodi Ifeoma J1 Ibeziako Ngozi S, 1 Anikene Chukwuemeka J1 Enemuo Eziamaka J1 Iloh Ogochukwu1 Nwogu Uloma2
1 Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu State, Nigeria,
2 Department of Radiography, College of Medicine
University of Nigeria Enugu Campus, Nigeria
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Introduction
The most common respiratory complaint was chronic cough in 271 (51.9%).
There were 65 (31.6%) cases of upper airway- related diseases and otitis media was predominant (27/65; 41.5%).
There were 141(68.4%) cases of lower airway related disease with pulmonary tuberculosis (115/141; 81.6%) being the lead cause.
Data on CXR was available in 458 children of which 142 (32%) of them had abnormal CXR, suggestive of bronchopneumonia, lobar pneumonia, PCP pneumonia, LIP, TB and bronchiectasis.
Of children who were thought to have a respiratory disease due to abnormality on chest x-ray, 72.5% (124/171) had concomitant clinical diagnoses of respiratory pathology compared to 18 (6.3%) of 287 without clinical diagnosis of respiratory infections but had abnormal chest x-ray (p<0.001).
After adjusting for confounding variables, socioeconomic status (p=0.04), children on second line HAART(p=0.03), and those with abnormal chest x-ray (p=0.02), remained significant risk factors for respiratory infection in children with HIV.
Respiratory illnesses are the most common presenting complaints and cause of morbidity among HIV-infected children.1-3
This study assesses the prevalence and risk factors for respiratory disease among HIV infected children.
Methods
10–year retrospective study conducted at the paediatric HIV clinic of the University of Nigeria Teaching Hospital, Enugu, South-East Nigeria.
The electronic medical records of all HIV-infected children seen between December 2004 and November 2015 were reviewed and necessary data extracted.
HIV diagnosis was made by HIV DNA PCR testing for children younger than 18 months and antibody testing for children ≥ 18 months.
Diagnosis of pneumonia was made using WHO Pneumonia Clinical Algorithm.4
Chest X-ray was used to confirm “pneumonic” changes
The chest x-ray interpretation was done by an independent consultant radiologist who was blinded to case note of patient.
Pulmonary TB diagnosis was done using clinical and radiological criteria.
Risk factors for respiratory pathologies included, age, presence of cough (chronic and acute), Socio-economic status (SES), and markers of disease severity (digital clubbing, CD4 viral load, HIV stage).
Data analysis
The data were analysed using the Statistical Package for Social Sciences (SPSS) version 19.0 (Chicago IL).
Student t test and Analysis of Variance (ANOVA) were used to compare means of continuous variables while chi-squared test was used to test association of categorical variables.
Regression analyses of risk factors for respiratory disease were also done.
P-values less than 0.05 were regarded as statistically significant and 95% confidence interval was reported where indicated.
Discussion
Otitis media was the most prevalent upper respiratory pathology while cough was the most commonly reported symptom. Mehta et al5 in India reported that 96% of their study participants presented with cough.
Similarly, Mehta et al5, also reported that tuberculosis is the most common respiratory infection.
When HIV is not diagnosed early, the patients are predisposed to several chest infections even at relatively high CD4+ counts,6 which can predispose to chronic lung infections. Children who commenced 2nd line HAART may have thus been more likely to have been diagnosed late and thus explaining why it is a risk factor as seen in our study.
The early initiation of antiretroviral therapy, when CD4+ count is still expectedly high, is known to have a modulating effect on respiratory outcome in children with HIV6
Chest x-ray finding supported the fact that still a veritable tool in detecting respiratory pathology
Conclusions
Results
There was a significant finding of respiratory disease among HIV infected children; with tuberculosis ranking the highest.
Low socioeconomic status, being on second line HAART and having abnormal chest x-ray are significant risk factors for respiratory infection among children with HIV.
555 HIV-infected children were included in the data analysis, with a mean age at HIV diagnosis of 5.3 ± 3.9 years, while the mean age at recruitment into the HIV clinic was 9.9 ±4.6 years
There were 206 respiratory cases diagnosed in 181 (34.7%) of study participants and these occurred either alone or in combination with other respiratory-related illness.
References
Zar HJ. Chronic lung disease in human immunodeficiency virus (HIV) infected children. Pediatr Pulmonol 2008;43: 1-10.
Miller R. HIV-associated respiratory diseases. Lancet 1996;348(9023):307–12.
Rennert WP, Kilner D, Hale M, Stevens G, Stevens W, Crewe-Brown H. Tuberculosis in children dying with HIV-related lung disease: clinical-pathological correlations. Int J Tuberc Lung Dis 2002; 6:
World Health Organization & UNICEF. Model Chapter for Text Books IMCI – Integrated management of Childhood illness. Department of Child and Adolescent Health and Development, Geneva WHO/FCH/CAH, 2001.
Mehta, AA, Anil KV, Vithalani KG, Patel KR. Clinico-epidemiological profile of HIV patients with respiratory infections and tuberculosis in Western India. JCDR 2011 (5); 2:
Abrams EJ. Opportunistic infections and other clinical manifestations of HIV disease in children. Pediatr Clin North Am 2000; 47: 79–108