HIV infection in hospitalized children with endemic diseases in Abakaliki, Nigeria: the role of clinically directed selective screening in diagnosis.

The increasing prevalence of HIV infection in Nigeria, its similar manifestations with endemic diseases and limited facilities for screening calls for judicious HIV testing. Children aged one month to 15 years admitted into the paediatric ward of the Ebonyi State University Teaching Hospital between January 2000 and September 2001 for various endemic diseases were reviewed retrospectively. Eight clinical risk factors commonly associated with HIV infection and endemic diseases present either singly or in combination, were reviewed to determine whether they could help to predict HIV infection and at what level and finally help formulate criteria for selective screening of HIV infection. Children above 18 months of age were diagnosed as being infected with HIV if they tested positive by two different HIV enzyme-linked immunosorbent assay (ELISA) tests. In children less than 18 months of age the diagnosis of HIV infection was made if they were ELISA positive and also fulfilled the WHO criteria for symptomatic HIV infection. Of the 282 children reviewed 31 (11.0%) were HIV positive giving a sero-prevalence rate of 4.1% of total admission. The HIV seropositive rate was highest in oral candidiasis (OC) (38.2%), followed by severe malnutrition (SM) (33.8%) then generalized lymphadenopathy (GLN) (31.4%). The presence of SM, GLN, OC and chronic dermatitis were highly significant independent risk factors for predicting HIV seropositivity (p<0.05). A marked shift towards the likelihood of HIV sero-positivity in the presence of at least two of the eight risk factors was documented. Children with two risk factors present had a 9.1 times more risk of being HIV sero-positive compared with those who had only one risk factor present (chi(2)=11.6, p=0.0007, OR = 9.1, 95% Cl = 2.5-32.8). Thirteen children (41.9%) representing a vast majority of HIV-positive children showed evidence of at least two of the eight clinical risk factors. As the number of risk factors concomitantly present increased, the chances of the child being infected with HIV also increase significantly (p<0.0001). Our study shows that clinically-directed selective screening in the presence of at least two risk factors should be carried out which does have a practical role in early diagnosis of HIV infection in a resource-poor setting.