CD4T LYMPHOCYTE SUBSETS AND DISEASE MANIFESTATION IN CHILDREN WITH AND WITHOUT HIV BORN TO HIV-1 INFECTED MOTHERS

ABSTRACTObjective: To understand the natural history of HIV-1 infection in children in termsof evolution of childhood clinical manifestations versus the immune status, we prospectivelystudied children with and without maternally transmitted HIV-1 infection born tomothers infected with HIV-1 for two years between March 1998 and March 2000.Design: A prospective cohort study.Setting: An institutional children’s home.Subjects: Fifty nine children (26 males and 33 females) with and without maternallytransmitted HIV-1 infection born to mothers infected with HIV-1 and adopted ininstitutional children home.Methods: HIV-1 status of children under nine months was confirmed by polymerasechain reaction(PCR). ELISA for HIV-1 antibody in serum/plasma was used to confirmHIV-infection status for children aged £18 months. Children were visited every threemonths between March and June 2000. At every visit blood was collected for total whitecell count, haemoglobin and CD4+ and CD8+ T cell counts. The institutional doctorroutinely examined children and treated all ailments. Clinical data were recorded.Measures: HIV-DNA, anti-HIV antibodies, total white blood count, total T cell counts,CD4 and CD8 T cell subset counts, frequency of childhood manifestations of infection.Results: The children were aged between 4.5 and 13 years. The baseline haematologicaland immunological profiles (mean, mode) were: HIV-1 sero-converters (WBC 7151,7150;HB 11.6, 12.0; CD4+ 686, 795; CD8+ 2168, 1507) and HIV-1 de-seroconverters (mean,mode) were: (WBC 8386, 7150; HB 11.7, 12.8; CD4+ 735, 795; CD8+ 2168, 1507). Thecommonest causes of illnesses among the HIV-1 children were URTI (85.3%), TB(56.1%),pneumonia (56.2%), tonsillitis (34.1%), parotiditis (28%) and acute otitis media (25%).The distribution of clinical manifestations was similar between the two categories ofchildren, except URTI, whose prevalence was significantly increased among HIV-1infected children (p-value=0.006). Among the HIV-1 infected children, only TB,parotiditis, and acute otitis media (AOM) were significantly associated with decreasedCD4+ T cell count (p<0.05) resulting from HIV infection.Conclusions: HIV infection in children predisposes them to common childhood infectionsthat can be used as markers of immune decline. TB, AOM, URTI may be early indicatorsof suspicion that would enable selective screening for HIV infection in children