Late diagnosis and HIV infection in children attending a service of specialized care for pediatric AIDS in Brazil

Dias, Carolina Frizzera; Moreira-Silva, Sandra Fagundes; Reis, Marcela Alice; Patrício, Luciana Ribeiro; Gavioli, Camila Fátima Biancardi; Miranda, Angélica Espinosa

doi:10.1590/0037-8682-1737-2013

Short Communications • Rev. Soc. Bras. Med. Trop. 47 (1) • Jan-Feb 2014 • https://doi.org/10.1590/0037-8682-1737-2013 linkcopy

Late diagnosis and HIV infection in children attending a service of specialized care for pediatric AIDS in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction: This study describes the frequency of late diagnosis and HIV among children attending a pediatric AIDS clinic.

Methods: Cross-sectional study in children exposed to HIV from 2005-2008. A questionnaire was given that included questions on demographics and clinical information.

Results: Two-hundred twenty-one (97.8%) children were exposed to HIV during pregnancy/childbirth. A total of 193 (87.3%) children had late enrolment in the service and late access to HIV serology. The frequency of HIV was 21.3% (95% confidence interval [CI] 15.9%-26.7%). Protective factors were earlier diagnosis [odds ratio (OR)=0.17 (0.08-0.37)] and receiving complete prophylaxis [OR=0.29 (0.09-0.97)]; being born by vaginal delivery was a risk factor [OR=4.45 (1.47-13.47)].

Conclusions: There was a high frequency of late diagnosis in this patient cohort. Earlier diagnosis is an important measure for controlling HIV among children.

HIV; AIDS; Children; Late diagnosis

Variables	Total		AIDS		No AIDS		OR (95%CI)
Variables	n	%	n	%	n	%	OR (95%CI)
Prenatal care
yes	178	80.5	28	59.6	150	86.2	0.23 (0.11-0.48)
no	43	19.5	19	40.4	24	13.8	1
ACTG complete protocol
yes	121	54.8	8	17.0	113	64.9	0.11 (0.05-0.26)
no	100	45.2	39	83.0	61	35.1	1
Prophylaxis during pregnancy
yes	132	59.7	10	21.3	122	70.1	0.11 (0.05-0.25)
no	89	40.3	37	78.7	52	29.9	1
Prophylaxis during delivery
yes	156	70.6	12	25.5	144	82.8	0.07 (0.03-0.15)
no	65	29.4	35	74.5	30	17.2	1
Prophylaxis in neonates
yes	171	77.4	17	36.2	154	88.5	0.07 (0.03-0.15)
no	50	22.6	30	63.8	20	11.5	1
Maternal breastfeeding
yes	47	21.3	30	63.8	17	9.8	16.29 (7.49-35.46)
no	174	78.7	17	36.2	157	90.2	1
Rupture of membranes > 4h
yes	21	9.4	7	14.0	14	8.0	1.86 (0.71-4.89)
no	200	90.6	40	86.0	160	92.0	1
Mode of delivery (n=212)
vaginal	95	44.8	32	82.1	63	36.4	7.98 (3.32-19.13)
cesarean	117	55.2	7	17.9	110	63.9	1

Variables	Odds ratio	95%CI	P Value
Age at enrolment in the service (<1 year vs >1 year)	0.17	0.08-0.37	<0.05
Sex (male vs female)	0.58	0.21-1.59	>0.05
Race (white vs non-white)	0.85	0.29-2.48	>0.05
Prenatal care (no vs yes)	3.00	0.69-13.05	>0.05
Complete prophylaxis (yes vs no)	0.29	0.09-0.97	<0.05
Mode of delivery (vaginal vs cesarean)	4.45	1.47-13.47	<0.05
Maternal breastfeeding (yes vs no)	0.79	0.56-1.10	>0.05
Maternal death (yes vs no)	0.894	0.737-1.08	>0.05

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[TFN01t01] HIV: human immunodeficiency virus; AIDS: acquired immunodeficiency syndrome; OR: odds ratio; 95%CI: 95% confidence interval; ACTG: AIDS Clinical Trials Group.