Paediatric HIV at the University of Port Harcourt Teaching Hospital, Port Harcourt

Background: HIV/AIDS is a major cause of infant and childhood morbidity and mortality in Africa. It is also an escalating problem of frightening proportions in Nigeria. Objectives: To determine the mode of transmission, clinical presentation, co-morbidity and the outcome among children with HIV/AIDS at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt. Methods: From January 2003 to December 2007, all children with HIV infection who registered in our clinic were followed up prospectively. Clinical and laboratoryevaluation were performed at presentation, the children were managed according to standard treatment guidelines and the outcome noted. Results: Of the 384 children with HIV infection, 190 (49.5 percent) were males and 194 (50.5 percent) females; a M: F ratio of 0.98:1. Their ages ranged from five months to 180 months. Two hundred and sixty three (68.5 percent) of the children were less than 18 months of age at presentation. Three hundred and forty six (90.1 percent) of the children acquired the infection vertically. The common symptoms at presentation in the 336 (87.5 percent) of the children who were symptomatic included fever in 75.3 percent, cough in 64.9 percent, weight loss in 41.1 percent and diarrhoea in 40.8 percent. The common signs were generalized lymphadenopathy in 44.1 percent, pallor in 39.3 percent and hepatomegaly in 38.1 percent. Common co-morbidities included tuberculosis in 23.7 percent and pneumonia in 15.4 percent. Majority (66.9 percent) presented in WHO stage 3 and 4. Twenty seven (7.0 percent) have died while 67 (17.4 percent) have been lost to follow up. Age specific mortality was highest among those aged below 18 months. The greatest contributors to case fatality were pneumonia (44.4 percent) and malnutrition (33.3 percent). Conclusion: Paediatric HIV/AIDS is predominantly transmitted from mother to child and constitutes a significant cause of childhood morbidity and mortality at the UPTH. In view of a high rate of those lost to follow up, it is advocated that strategies such as support groups and expert patient training should be put in place to track down defaulters.