Simple markers for the detection of severe immunosuppression in children with HIV infection in highly resource-scarce settings: experience from the Democratic Republic of Congo

• Published in: Pathogens and global health 2015-09, Vol.109 (6), p.300-304
• Main Authors: Aketi, Loukia, Tshibassu, Pierre M., Kayembe, Patrick K., Kitetele, Faustin, Edidi, Samuel, Ekila, Mathilde B., Wumba, Roger, Lepira, François B., N. Aloni, Michel
• Format: Article
• Language: English
• Subjects: Adolescent; Africa; AIDS-Related Opportunistic Infections - economics; AIDS-Related Opportunistic Infections - epidemiology; AIDS-Related Opportunistic Infections - immunology; Anti-HIV Agents - administration & dosage; Antiretroviral therapy; Biomarkers - blood; Candidiasis, Oral - immunology; CD4; CD4-Positive T-Lymphocytes - metabolism; Child; Child, Preschool; Children; Cross-Sectional Studies; Delivery of Health Care; Democratic Republic of the Congo - epidemiology; Female; Health Resources; Highly resource-scarce settings; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - economics; HIV Infections - immunology; Humans; Immunosuppression; Kinshasa; Male; Practice Guidelines as Topic; Short Communication; Simple markers; The Democratic Republic of Congo; Viral load
• ISSN: 2047-7724; 2047-7732
• DOI: 10.1179/2047773215Y.0000000025

The decision to initiate the antiretroviral therapy in HIV-infected children living in poor countries is compromised by lack of resources. The objective of this study is to identify simple clinical and biological markers other than CD4+ count and viral load measurement that could help the decision to introduce antiretroviral treatment and to monitor patients. A cross sectional study was conducted between January and March 2005 in Kinshasa, Democratic Republic of Congo. Eighty-four children infected with HIV were recruited. In this cohort, the lymphocytes (P = 0.001) and CD4 (P = 0.0001) were significantly lower in children with immunological stage 3 and viral load (P = 0.027) was significantly higher in children at the same immunological stage. Reticulocytes (r = +0.440), white blood cells count (r = +0.560), total lymphocytes (r = +0.675) and albumin (r = +0.381) showed positive significant correlations with CD4. Haemoglobin (r = − 0.372), Haematocrit (r = − 0.248), red blood cells (r = − 0.278) and CD4 (r = − 0.285) showed negative significant correlations with viral load. Neutropaenia (P = 0.02), enlarged nodes (P = 0.005) and oral candidiasis (P = 0.04) were associated with viral load >10 000 copies/ml. Oral candidiasis (P = 0.02) was associated with CD4 level