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Evaluation of the WHO clinical case definition of AIDS for pediatric AIDS in the Indian context
Presented by Tripti Pensi, India.
Banerjee T.1, Grover G.1, Pensi T.2, Gadpayle A.K.3
1University of Delhi, Statistics, Delhi, India, 2Dr.Ram Manohar Lohia Hospital, Pediatrics, Delhi, India, 3Dr.Ram Manohar Lohia Hospital, Medicine, Delhi, India
Objectives: The need of a clinical case definition (CCD) for AIDS was felt by public health agencies to monitor diseases resulting from HIV infection. Present study undertaken to provide modified clinical classification as a tool of managing children in resource limited settings where CD4 count is still not easily available.
Methods: Medical record review
Random sample of patients attending the pediatrics OPD
During October 2005 – December 2006
Age Group: 18 months – 12 years
Predictive values, sensitivity, specificity computed based on presence of 3 major and 2 minor signs & 2 major and 2 minor signs of WHO CCD and also computed for the same based on 13 clinical signs and symptoms.
Logistic regression used to identify significant parameters.
Results: N = 360
Evaluation of WHO CCD in 360 patients (60 seropositives) based on
1) 3 major and 2 minor signs
Sensitivity= 21.67%
Specificity= 95.33%
PPV= 48.15%
2) 2 major and 2 minor signs
Sensitivity= 58.33%
Specificity= 90%
PPV= 53.84%
Logistic Regression Analysis based on 3 major and 2 minor signs revealed weight loss, chronic fever> 1 mo and TLyC as the predictor variables for HIV seropositivity in children (b= 4.825,5.015,5.395 respectively) with p value <0.0001. Sensitivity, specificity and PPV as computed were 73.33%, 90.67% & 61.11%.
Logistic Regression Analysis based on 2 major and 2 minor signs revealed weight loss, chronic diarrhoea> 1 mo, chronic fever> 1 mo, TLyC, recurrent bacterial infection and chronic cough w/o TB as the predictor variables for HIV seropositivity (b= 4.246, 6.287, 4.999, 6.398, 3.818, 4.247 respectively) with p value <0.05. Sensitivity, specificity and PPV as computed were 86.66%, 88.66% & 60.46%.
Conclusions: Based on these findings, we propose a clinical case definition based on 13 clinical signs and symptoms for pediatric AIDS in India with better sensitivity and PPV but similar specificity than the WHO case definition.
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Disclaimer: This additional information has been submitted by the abstract
author after the abstract has been accepted for the conference and has not been
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