Making a working clinical diagnosis of HIV infection in infants in Zimbabwe

Clinical algorithms can be helpful in decisions about treatment and feeding options in infancy, but have had limited exposure to real data. This analysis uses data from a large clinical trial to test such algorithms, and thereby develop a successor which performs usefully in poor countries with high...

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Bibliographic Details
Published in:Tropical medicine & international health 2008-12, Vol.13 (12), p.1459-1469
Main Authors: Iliff, Peter, Ntozini, Robert, Nathoo, Kusum, Piwoz, Ellen, Moulton, Lawrence, Humphrey, Jean
Format: Article
Language:English
Subjects:
Algorithms
Babies
Biological and medical sciences
Body Height
Body Weight
Developing Countries
diagnosis
diagnostic
diagnóstico
Female
Follow-Up Studies
General aspects
HIV
HIV Infections - diagnosis
HIV Infections - transmission
Human immunodeficiency virus
Human viral diseases
Humans
IMCI
Immunodeficiencies
Immunodeficiencies. Immunoglobulinopathies
Immunopathology
Infant
Infant, Newborn
Infectious Disease Transmission, Vertical - prevention & control
Infectious diseases
integrated management of childhood illness
Medical diagnosis
Medical sciences
mortalité infantile
niño
PCIME
Pregnancy
Pregnancy Complications, Infectious - diagnosis
VIH
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
Zimbabwe
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Summary:Clinical algorithms can be helpful in decisions about treatment and feeding options in infancy, but have had limited exposure to real data. This analysis uses data from a large clinical trial to test such algorithms, and thereby develop a successor which performs usefully in poor countries with high HIV-prevalence. The ZVITAMBO trial followed 14 110 mother-baby pairs through infancy. 32% of mothers were HIV-positive. Infants were HIV tested regularly using DNA PCR. Clinical signs were evaluated in terms of identifying HIV-infection at 6 weeks, 6 and 12 months, using Zimbabwean, South African, and WHO generic adaptations of the WHO integrated management of childhood illness HIV algorithm. A modification, in which HIV-exposed infants are first divided into being at least or less than median weight-for-age, was derived and evaluated. At 6 weeks 65% of all infected babies are less than median weight-for-age. Adding at least two clinical signs reduces sensitivity to 20% but those identified are 1.5 (95% CI 1.1-2.1) times more likely to die by 6 months than other infected infants. At 6 months, 86% of uninfected babies of HIV-infected mothers can be identified by selecting those whose weight is greater than median or, if less than median, who exhibit
ISSN:1360-2276
1365-3156
DOI:10.1111/j.1365-3156.2008.02178.x