| CD4 Count, HIV Viral Load and Enteric
Pathogens in HIV-Infected Children with Persistent Diarrhoea in Durban, S. Africa Rollins
NC1, Pent M2, Kindra G1, Kasambira T2, Sturm W3,
Steele D4, Skolnik PR2, Bennish ML5.
1Paediatrics and Child Health, University of Natal, S. Africa; 2
Tufts University School of Medicine, USA; 3Microbiology, University of Natal,
S. Africa; 4Diarrhoeal Pathogens Research Unit, MEDUNSA, S. Africa; 5
Africa Centre for Health and Population Research, S. Africa.
Introduction: Persistent diarrhoea is a common problem for HIV-infected children
in Africa. At King Edward VIII Hospital in Durban, 32% of 1100 paediatric diarrhoea
in-patients yearly have HIV infection. There is little information on the pathogens
causing persistent diarrhoea in these children, and on the relationship between the
infecting pathogen and the stage of HIV/AIDS. Such information would help in the
management of this condition.
Methods: Blood and stool samples were collected from HIV-infected children 6 to
36 months coming to King Edward VIII Hospital with diarrhoea lasting > 7 days for
routine culture and for TB, C. parvum and G. lamblia (by direct microscopy
and immunofluorescence), and rotavirus and astrovirus (by ELISA). The study was approved
by the UND ethics committee.
Results: Mean age of 101 patients enrolled was 14.9 m. Study children were a
mean 64% of median weight-for-age. CD4 counts, HIV in plasma and enteric pathogens were
available on all 101 children; viral enteric studies were available on 59. 8 w follow-up
data was available on 84. Median HIV RNA was 1.197 x 106 copies/ml (range:
502-21.9 x106 copies/ml) and CD4 count was 726 x103/ml (range
12-2,880). C. parvum was identified in 25 (24.8%) children, C. jejuni in 10
(9.9%), C. coli in 2 (2%), rotavirus in 7/59 (11.9%), M. tuberculosis in one
(0.9%) and an acid fast bacillus in one(0.9%). No enteric pathogen was identified in 60
(58.8%) children. There was no correlation between enteric pathogen and viral load.
However, C. parvum infected children had significantly lower CD4 counts (g.mean:
299 vs. 648 x103/ml, p=0.002) and CD4:CD8 ratio (g.mean: 0.195 vs. 0.366,
p=0.004). C. parvum-infected children did not differ from other children in age,
weight-for-age or plasma HIV RNA. Significantly more C. parvum-infected children
died within 8 weeks of admission than children who were not infected (6/16 vs. 7/68, p =
0.007).
Conclusions: C. parvum is commonly associated with
persistent diarrhoea in children with advanced HIV infection in S. Africa and is
associated with a lower CD4 count and higher mortality. Few easily treatable enteric
infections were identified in these children. |