A Clinical Snapshot of Hospitalized, Newly Diagnosed, HIV-positive Malawian Children Reveals Opportunities for Improved HIV Healthcare Delivery

Description

Oral presentation at annual meeting of the American Society of Tropical Medicine and Hygiene

Theresa Madaline1, Sarah Hochman1, Karl Seydel2, Terrie Taylor2, Alice Liomba3, Alex Saidi3, Grace Matebule4, Lario Chigaru4, Bernadette O'Hare3, Dan Milner5, Kami Kim1
1Albert Einstein College of Medicine, Bronx, NY, United States, 2Michigan State University, East Lansing, MI, United States, 3University of Malawi College of Medicine, Blantyre, Malawi, 4Queen Elizabeth Central Hospital, Blantyre, Malawi, 5Harvard Medical School, Boston, MA, United States

Abstract

n Malawi, all HIV-positive children under 5 years old qualify for antiretroviral treatment (ART), but CD4+ T cell quantification (CD4 count), when available, or WHO clinical staging of HIV severity is used to determine ART eligibility for children ≥5 years old. Few studies have examined the clinical or immunological status of older children with newly diagnosed HIV infection. We studied children ≥ 18 months of age admitted to Queen Elizabeth Central Hospital in Blantyre, Malawi, from May 2013-June 2014. Initial HIV testing followed the WHO-recommended serial testing algorithm using HIV rapid diagnostic tests (RDT) Determine and Uni-Gold. Guardians of 222 children with positive HIV RDT consented to CD4 count and HIV-1 RNA PCR (HIV VL) while in hospital. We examined age, discharge diagnosis, total and percent CD4 count, HIV VL, and clinical HIV stage using 2013 WHO guidelines. Median age of the children was 48 months (range 18-192 months) and median absolute CD4+ T-cell count was 541 cells/mm3 (range 1-3888 cells/mm3). Of the 182 subjects with HIV VL results, 16 had low (<1000 copies/ml) or undetectable HIV VL, prompting confirmatory HIV Western Blot and Enzyme Immunoassay. Ten out of 16 patients had positive confirmatory HIV serological testing, consistent with elite-controller status, while 6 had negative confirmatory test results, indicating that 3.3% of children incorrectly reported to have positive HIV RDTs were not HIV seropositive. The most common reasons for hospitalization were sepsis (n=43, 19%), pneumonia (n=42, 19%), malaria (n=38, 17%), malnutrition (n=36, 16%), and meningitis (n=14, 6%). There was poor correlation between clinical and immunologic staging. Of patients aged ≥5 years (n=106), 33% (n=35) qualified for ART by CD4 count but would have been ineligible by WHO clinical stage alone. These findings highlight the importance of regular quality assessment and need for confirmatory testing prior to initiating ART, and support the current WHO algorithm of routine staging of all children, initiation of ART in children who are WHO stage III or IV, and obtaining CD4 count in children who are stage I or II.

Period	25 Oct 2015 → 29 Oct 2015
Event type	Other
Sponsor