Clinical aspects of pediatric AIDS cases notified in the state of Amazonas, 1991-2009

LETTER TO THE EDITOR

Clinical aspects of pediatric AIDS cases notified in the state of Amazonas, 1991-2009

Claudia Marques de Oliveira Soeiro^I; Angelica Espinosa Miranda^II; Valeria Saraceni^III; Sinesio Talhari^IV; Luiz Carlos de Lima Ferreira^V

^IMSc, PhD Student in Tropical and Infectious Diseases, Universidade do Estado do Amazonas (UEA) and Fundação de Medicina Tropical do Amazonas (FMTAM); Professor, UEA, Brazil

^IIPhD, Professor, Universidade Federal do Espírito Santo, Center of Infectious Diseases, Brazil

^IIIPhD; Health Surveillance Superintendence, City Secretary of Health and Office of Civil Defense of Rio de Janeiro, Brazil

^IVPhD; Professor Universidade Federal do Amazonas/ FMTAM, Brazil

^VPhD, Universidade Federal do Amazonas/ FMTAM, Brazil

^{Correspondence to}

Dear Editor,

The clinical course of AIDS is faster in the child in comparison to the adult due to the child's immature immunological system.¹ Diagnosis in children is a challenge, as the clinical presentations are similar to other diseases common in childhood.² Early diagnosis of HIV infection, in children identified as having been exposed to the virus, as well as in those that have non-specific constitutional symptoms, demanding recurrent medical attention, will determine the prognosis of these children.³

We conducted a descriptive study based on pediatric AIDS data gathered by the Brazilian National Health Information System (Sistema de Informação Nacional de Agravos de Notificação - SINAN) of the Amazonas state, from de 1991 to 2009. The statistical analysis was performed using the MINITAB 14 software. The study was approved by the Ethics Research Committee of Fundação de Medicina Tropical do Amazonas/FMTAM.

The clinical symptoms of HIV infection (almost always non-specific) are used by pediatricians for early diagnosis of infected children. Children that frequently return to healthcare services with fever, diarrhea and recurrent infections, in addition to non-specific lymphadenopathy and enlarged parotid glands must have their clinical, family and epidemiological history thoroughly investigated to ensure that the HIV diagnosis is not missed, considering that mother-to-child transmission prevention was not implemented during pregnancy.

A total of 138 children with AIDS were reported in the study period, of which 58% were male, with a median age of 3 years. In only 23 cases (17%) laboratory evidence of HIV infection was obtained before 18 months of life. The other cases were diagnosed later, taking into account the clinical picture consistent with HIV infection, going against the recommendations for identification of the infected mother during pregnancy to prevent cases of pediatric AIDS.⁴

Of the total number of pediatric AIDS cases reported to SINAN-AM, less than 10 cases/year were reported from 1991 to 2002, with a sudden increase to 30 cases in 2003 followed by a decrease to a mean of 8 cases/year from 2004 to 2007; this number increased again to 32 in 2008. Only six cases of pediatric AIDS were reported in 2009, showing a local flactuation of mother-to-child transmission of HIV.

Table 1 shows that among the clinical criteria of mild severity for AIDS diagnosis in children the most frequent were the presence of lymphadenopathy > 0.5 cm in more than two sites in 55% of the cases and persistent dermatitis in 46%. Other studies carried out in Brazil encountered similar results.^5-7

Among the clinical criteria of severity (moderate/severe), recurrent or chronic diarrhea occurred in 44% of the cases, followed by recurrent bacterial infections in 43% and anemia in 41% of the cases. These were the most common manifestations of AIDS and were the main AIDS-defining diseases in the present study. Pulmonary manifestations were a common cause of hospital admission in other studies.^8,9

The assessment of children exposed to HIV infection must be carried out, ensuring a thorough clinical and laboratory investigation, aiming at an early diagnosis and adequate treatment of possible concomitant diseases. Such practice aims at decreasing the morbidity related to fever, diarrhea and recurrent infections, in addition to non-specific lymphadenopathy and parotid enlargement. The clinical, family and epidemiological history must be thoroughly assessed so that the HIV diagnosis is not missed, since the chance of preventing mother-to-child transmission of HIV has already been missed during pregnancy.

Submitted on: 02/20/2011

Approved on: 02/21/2011

We declare no conflict of interest.

• 1. Bagenda D, Nassali A, Kalyesubula I et al. Health, neurologic, and cognitive status of HIV-infected, long-surviving and antiretroviral-naive Ugandan children. Pediatrics 2006;117:729-40.
• 2. Machado ARL, Silva CLO, Dutra CE et al. AIDS na infância: orientação básica no atendimento. J Pediatr (Rio J) 1994;1(70):5-9.
• 3. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Programa Nacional de DST e AIDS. Recomendações para terapia antirretroviral em crianças e adolescentes infectados pelo HIV, Brasília; Brasil. Ministério da Saúde; 2009. 211 p. tab. (Manuais, 85).
• ⁴
  Secretaria de Vigilância em Saúde. Programa Nacional de DST e AIDS. Recomendações para Profilaxia da Transmissão Vertical do HIV e Terapia Antirretroviral em Gestantes 2010. Versão preliminar publicada em Portaria SVS/MS Nº 151, de 14 De Outubro de 2009 DOU 16.10.2009 Ministério da Saúde, Brasília, 2010.
• 5. Pinheiro Neto CD, Weber R, Araújo-Filho BC et al. Rhinosinusitis in hiv-infected children undergoing antiretroviral therapy. Braz J Otorhinolaryngol 2009;75(1):70-5.
• 6. Carvalho VO, Luzilma LP, Martins TF Et al. Alterações dermatológicas em crianças com AIDS e sua relação com categorias clínico-imunológicas e carga viral. An Bras Dermatol, 2003;78(6):679-69.
• 7. Silva EB, Grotto HZW, Vilela MMS. Aspectos clínicos e o hemograma em crianças expostas ao HIV-1: comparação entre pacientes infectados e soro-reversores. J Pediatr (Rio J) 2001;6(77):503-11.
• 8. Yparraguirre ITR, Sant'anna CC, Lopes VGS et al. Acometimento pulmonar em crianças com a síndrome da imunodeficiência humana (AIDS): estudo clínico e de necrópsia de 14 casos. Rev Ass Med Brasil 2001;47(2):129-36.
• 9. Vieira MBC, Cardoso CAA, Carvalho AL et al. Perfil das crianças infectadas pelo vírus da Imunodeficiência Humana (HIV), internadas em hospital de referência em infectologia pediátrica de Belo Horizonte/MG, 2003. Rev Med Minas Gerais 2008;18(2):82-6.

Publication Dates

• Publication in this collection
  15 Aug 2011
• Date of issue
  Aug 2011