As the world enters the third decade of the acquired immunodeficiency syndrome (AIDS) epidemic, the evidence of its impact is undeniable. Infection with the human immunodeficiency virus (HIV) is now a major public health problem for both developing and developed countries as it has dramatically increased the global burden of disease. The global impact of the HIV epidemic has been so dramatic and devastating that it has been described as the "epidemic of our century".

About 95% of HIV/AIDS infected people are living in developing countries, which have to cope with the huge burden of suffering and death.

HIV infection has been studied extensively in adult age group. But pediatric HIV infection is a relatively newer field and has not been extensively studied in Indian children. There are only few published reports on the clinical manifestations of pediatric HIV infection and opportunistic infections in India. Our study intends to describe the clinical manifestations and laboratory profile of HIV infection and also to know the patterns of opportunistic infection among these children.

» Materials and Methods

Children between the age group of 18 months to 12 years admitted to pediatric medical ward at KIMS Hospital, Hubli, from April 2004 to June 2005 (15 months period) with confirmed HIV infection were enrolled in the present study. Children below 18 months were not included in the present study because of diagnostic difficulties. The diagnosis of HIV infection was confirmed by three positive ELISA tests using three different HIV-ELISA kits on same sera, according to WHO strategy-III. All subjects were asked to follow up after discharge at high-risk clinic for HIV at least once a month to rule out and to treat opportunistic infections.

In all the seropositive cases, a detailed history was taken with special reference to the source of infection, presenting complaints, prior history of infections, risk factors, parental sero-status, sibling status, natal history, immunization status, developmental history, dietitic history and socio-demographic characteristics. A detailed examination, including anthropometry and clinical manifestations were recorded in a predesigned proforma. A wide spectrum of laboratory investigations including complete hemogram with total lymphocyte count, Mantoux test, chest X-ray, USG abdomen, blood culture, urine and stool examination, and FNAC of lymph node were carried out for all children. The other investigations like ear swab, CSF examination, CT scan and CD4 count were done on selective patients. The opportunistic infections were diagnosed using presumptive criteria and relevant investigations, wherever possible. Children were categorized as per 1994 revised CDC classification of pediatric HIV.

» Results

A total of 71 children were confirmed with HIV test during study period. The age range was from 18 months to 12 years. More than 98% of the cases were below the age of 10 years. Youngest child in the present study was 18 months and the oldest was 11 years. Mean age of presentation in the present study was 5.75 years. Maximum cases in the study were males, constituting 63.38% (2/3) of the cases. Maximum cases in males were seen in the age group of 1.5 - 5 years constituting 35.21%. Among females the maximum cases were seen in the age group of 5 - 10 years constituting 21.13%. Majority were from hindu community constituting 77.46% (>3/4) of cases.