Profile of HIV infected children from Delhi and their response to antiretroviral treatment.

OBJECTIVES (i) To study the clinical and immunological profile of HIV infected children attending the ART centre; (ii) To correlate CD4 count with clinical staging at diagnosis; and, iii) To study the clinical and immunological response to antiretroviral treatment. SETTING Antiretroviral therapy (ART) centres of two tertiary care hospitals of Delhi. PATIENTS 100 children attending the centres between December 2008 to June 2009. METHODS The clinical features, immunological profile (CD4 count) and response to ART were recorded in a structured proforma. DESIGN Prospective follow-up. RESULTS Average age of enrolled children was 6.24 y (range 1-14 years) and mode of transmission was parent to child in 92%. Most common clinical presentation was fever (83%), cough (50.8%) and diarrhea (38.9%). Tuberculosis was the most common opportunistic infection seen in 11% of children. 59% of enrolled children were malnourished. Antiretroviral treatment (ART) was initiated in 33 children. Children who were initiated on ART had a significant improvement in both clinical and immunological staging at the 6 months follow up. Immunological response (rise in CD4 count) to ART was better in children with lesser degree of immunosuppression. The measure of agreement between the clinical and immunological stage at presentation was poor. CONCLUSIONS Baseline CD4 counts rather than clinical staging can be a primary determinant for initiation of antiretroviral treatment in HIV infected children.