Dataset Information

Validation of 2006 WHO prediction scores for true HIV infection in children less than 18 months with a positive serological HIV test.

ABSTRACT:

Introduction

All infants born to HIV-positive mothers have maternal HIV antibodies, sometimes persistent for 18 months. When Polymerase Chain Reaction (PCR) is not available, August 2006 World Health Organization (WHO) recommendations suggest that clinical criteria may be used for starting antiretroviral treatment (ART) in HIV seropositive children <18 months. Predictors are at least two out of sepsis, severe pneumonia and thrush, or any stage 4 defining clinical finding according to the WHO staging system.

Methods and results

From January 2005 to October 2006, we conducted a prospective study on 236 hospitalized children <18 months old with a positive HIV serological test at the national reference hospital in Kigali. The following data were collected: PCR, clinical signs and CD4 cell count. Current proposed clinical criteria were present in 148 of 236 children (62.7%) and in 95 of 124 infected children, resulting in 76.6% sensitivity and 52.7% specificity. For 87 children (59.0%), clinical diagnosis was made based on severe unexplained malnutrition (stage 4 clinical WHO classification), of whom only 44 (50.5%) were PCR positive. Low CD4 count had a sensitivity of 55.6% and a specificity of 78.5%.

Conclusion

As PCR is not yet widely available, clinical diagnosis is often necessary, but these criteria have poor specificity and therefore have limited use for HIV diagnosis. Unexplained malnutrition is not clearly enough defined in WHO recommendations. Extra pulmonary tuberculosis (TB), almost impossible to prove in young children, may often be the cause of malnutrition, especially in HIV-affected families more often exposed to TB. Food supplementation and TB treatment should be initiated before starting ART in children who are staged based only on severe malnutrition.

SUBMITTER: Peltier CA

PROVIDER: S-EPMC2669178 | biostudies-literature | 2009

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Validation of 2006 WHO prediction scores for true HIV infection in children less than 18 months with a positive serological HIV test.

Peltier Cécile Alexandra CA Omes Christine C Ndimubanzi Patrick Cyaga PC Ndayisaba Gilles François GF Stulac Sara S Arendt Vic V Courteille Olivier O Muganga Narcisse N Kayumba Kizito K Van den Ende Jef J

PloS one 20090424 4

<h4>Introduction</h4>All infants born to HIV-positive mothers have maternal HIV antibodies, sometimes persistent for 18 months. When Polymerase Chain Reaction (PCR) is not available, August 2006 World Health Organization (WHO) recommendations suggest that clinical criteria may be used for starting antiretroviral treatment (ART) in HIV seropositive children <18 months. Predictors are at least two out of sepsis, severe pneumonia and thrush, or any stage 4 defining clinical finding according to the ...[more]

PMID: 19390690

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Project description:BackgroundThe Step Test (ST) is a measure of dynamic standing balance and paretic-lower-extremity motor control in patients with stroke. Little is known about the extent to which impairments assessed by the ST relate to activity and participation during stroke recovery.ObjectiveThe purpose of this study was to determine relationships between ST scores and measures of activity and participation during the first 6 months after stroke.DesignThis was a prospective cohort study.MethodsThirty-three individuals (18 men, 15 women) with a diagnosis of a single, unilateral stroke participated in the study. Participants were tested one time per month from 1 to 6 months poststroke. The ST was considered an impairment-level measure. Self-selected gait speed and the MedicalOutcomesStudy 36-Item Short-Form Health Survey (SF-36) Physical Function Index (PFI) were used to assess physical function. Three domains (mobility, basic and instrumental activities of daily living, participation) of the Stroke Impact Scale were used to assess self-reported disability. Regression analyses were conducted to examine the bivariate associations between ST scores and each physical function and disability measure at each time point (1-6 months).ResultsThe ST scores were positively associated with both physical function measures. The associations were stronger for self-selected gait speeds (R(2)=.60-.79) than for the PFI scores (R(2)=.32-.60). During the first 6 months after stroke, each additional step with the paretic lower extremity on the ST corresponded to a 0.07-m/s to 0.09-m/s increase in gait speed, and each additional step with the nonparetic lower extremity was associated with a 0.07-m/s to 0.08-m/s gait speed increase. The impairment-disability associations were weaker than the impairment-physical function associations.LimitationsLimitations of the study include a relatively small sample size and lack of examiner blinding with regard to participant characteristics.ConclusionsImpairments in balance and paretic-lower-extremity motor control, as measured by the ST, relate to physical function and disability during the first 6 months following stroke.

Dataset Information

Validation of 2006 WHO prediction scores for true HIV infection in children less than 18 months with a positive serological HIV test.

Introduction

Methods and results

Conclusion

Publications

Validation of 2006 WHO prediction scores for true HIV infection in children less than 18 months with a positive serological HIV test.

Similar Datasets

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