Paediatrics HIV/AIDS: Clinical presentation and practical management challenges in Sokoto, Nigeria

Background: Implications of continuing HIV/AIDS pandemic in Nigeria is very grave for children. Lack of financial resources means care of children with HIV/AIDS is exceedingly difficult to provide. We described the clinical pattern and highlight the problems in the management of HIV/AIDS in children seen in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria over a two-year period. Methods: This prospective study was carried out between 1 st January 2001 and 31 st December 2002. The clinical presentation of each patient satisfying the WHO diagnostic criteria for paediatrics HIV/AIDS, admitted consecutively into our Emergency Paediatrics Unit (EPU) was documented. Laboratory diagnosis was by Enzyme linked immunosorbent assay (ELISA) for HIV- I and HIV- II in affected children and their mothers while confirmatory test was by Western blot. Treatment of each patient was individualised. Results: A total of 41 children with HIV/AIDS were admitted into EPU over the study period. There were 22 males and 19 females with ratio of 1.2:1. Age ranged from 0.25 years to 14 years with mean (SD) of 1.5 (2.2) years. Forty - one (97.6%) patients were aged 5 years and below. Modes of transmission were vertical in 40 (97.6%), while 1 (2.4%) was by homosexual abuse. The commonest clinical feature was weight loss in 41 (100%), followed by fever (>one month) 39 (95%), chronic diarrhoea 39 (95%), recurrent cough 37 (90%) and oro-pharyngeal candidiasis 35 (85%) in that order. Thirty- six (87.8%) patients had protein - energy malnutrition (PEM), marasmus constituting 58%. Thirty-two (78%) patients were in WHO clinical stage 3 while the remaining 9 (22%) patients were in stage 4. The main types of infections were oral candidiasis, pneumonia, malaria, septicaemia, urinary tract infections, and tuberculosis. Case fatality rate was 91%. Highly active antiretroviral therapy (HAART) was not freely available to children during the period of our study. Conclusion: The mortality of these antiretroviral naive HIV/AIDS children was very high. It is anticipated that current availability of HAART to children free of charge would improve the outcome of HIV/AIDS in this group