Manifestations in human immunodeficiency virus infected children at Kenyatta National Hospital

Abstract

Objective: To compare the prevalence of various dermatological conditions between highly active antiretroviral therapy (HAART) - naive human immunodeficiency virus (HIV) - infected children and HIV uninfected children at Kenyatta National Hospital (KNH). Design: Cross-sectional study. Methodology: HIV infected children were selected consecutively from the Comprehensive Care Centre (CCC) and the paediatric wards of KNH between September 2007 and February 2008. HIV uninfected children were also selected consecutively from the paediatric wards of KNH and matched for age with the HIV infected children. Patients were classified into four immune categories and a cluster of differentiation (CD) 4 cell count and CD4 percentage of total lymphocytes was performed on the HIV infected children. A medical history primarily focusing on skin symptoms and a complete physical examination was carried out on all the patients. Detailed examination of the skin from head to toe was undertaken. A clinical diagnosis of skin lesions was made by the principal investigator under the supervision of a consultant dermatologist. A digital camera was used to take photographs of the skin lesions. The history and physical examination findings, together with the results of all the investigations done on the day of the assessment, were recorded in the questionnaire/ record sheet. The data obtained was analyzed and conclusions and recommendations drawn from the results. Results: The prevalence of skin conditions in HIV infected and HIV uninfected children was 37.0% (95% Cl 27.5%-46.5%) and 21.0% (95% Cl 13.0%-29.0%) respectively. Skin conditions were significantly more frequent (p=0.01) among HIV infected children. Prevalence of skin conditions in WHO stage 1, 2 and 3 was 20.0%, 27.5% and 57.6% respectively. Children with advanced HIV disease (WHO stage 3 and 4) had a significantly higher prevalence of skin disease (p=0.005) than those in stage 1 and 2. HIV infected children with a skin condition had significantly lower CD4 counts (p=0.003) and CD4% (p=0.001) than those without a skin condition. Conclusions: Skin conditions were significantly more prevalent in HIV infected children as compared to HIV uninfected children. Skin conditions were significantly more prevalent in children with advanced HIV disease and lower CD4 count and percentage.