Prazuck T, Tall F, Nacro B, Rochereau A, Traore A, Sanou T, Malkin J E, Apaire-Marchais V, Masson D, Dublanchet A
Groupe d'Etudes Epidémiologiques et Prophylactiques (GEEP), Villeneuve St Georges, France.
AIDS. 1993 Jan;7(1):103-8.
To define a clinical profile indicative of HIV infection in a population of severely malnourished children in Burkina Faso. A total of 433 children (average age, 19 months) were recruited at the Sanou Souro National Hospital, Bobo Dioulasso, Burkina Faso.
Sixty-three per cent presented with marasmus, 13% with kwashiorkor and 24% with both forms of malnutrition. The prevalence of HIV infection in children aged over 12 months was 13.8%, with a marked predominance of HIV-1 (95.8%). Mother-to-child transmission was proven in 77% of the cases; in 10% of the observed paediatric AIDS cases, transmission may have occurred through multi-injections with contaminated equipment. Marasmus was the form of malnutrition most frequently associated with HIV (P < 0.001); its severity was exacerbated by HIV infection. Adenopathy (P < 0.0001), oral candidiasis (P < 0.0006), skin disorders (P < 0.01) and hepatomegaly (P = 0.01) appeared to be significantly related to HIV infection. Discriminant analysis revealed that the presence of adenopathies was the strongest indicator symptom of HIV infection. Multivariate analysis revealed that a clinical profile of marasmus, adenopathies and oral candidiasis (specificity, 82%) was indicative of HIV infection in this population. The short-term clinical prognosis was poor and usually led to the death of the child when seropositive (P < 0.001).
Among children exhibiting severe malnutrition, HIV-positive children are distinguished by a high horizontal transmission rate, a high specific clinical profile and a very poor prognosis.
确定布基纳法索重度营养不良儿童人群中提示感染艾滋病毒的临床特征。在布基纳法索博博迪乌拉索的萨努·苏罗国家医院招募了总共433名儿童（平均年龄19个月）。
63%表现为消瘦型营养不良，13%为夸希奥科病，24%为两种营养不良形式并存。12个月以上儿童的艾滋病毒感染率为13.8%，其中HIV-1占明显优势（95.8%）。77%的病例证实为母婴传播；在观察到的儿童艾滋病病例中，10%可能是通过使用受污染设备多次注射而感染。消瘦型营养不良是最常与艾滋病毒相关的营养不良形式（P<0.001）；艾滋病毒感染加剧了其严重程度。淋巴结病（P<0.0001）、口腔念珠菌病（P<0.0006）、皮肤疾病（P<0.01）和肝肿大（P=0.01）似乎与艾滋病毒感染显著相关。判别分析显示，淋巴结病的存在是艾滋病毒感染最强的指示症状。多变量分析显示，消瘦型营养不良、淋巴结病和口腔念珠菌病的临床特征（特异性为82%）提示该人群感染了艾滋病毒。短期临床预后较差，血清反应阳性的儿童通常会死亡（P<0.001）。
在重度营养不良的儿童中，艾滋病毒阳性儿童的特点是水平传播率高、具有特定的临床特征且预后极差。
