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Evaluation of Efficacy of WHO case definition criteria for diagnosis of AIDS in children
Presented by Rasika Gadkari, India.
Gadkari R.1, Dhande L.1, Chande C.1, Ughade S.1, Warhadpande U.1
1Govt. Medical College, Pathology, Nagpur, India
Objectives: To evaluate Positive and Negative Predictive Value, specificity, Sensitivity and likelihood ratios of WHO case definition criteria for diagnosis of AIDS in children
Methods: Methodology: Hospital Based observational study Sample size: 200 Duration of Study: One year Study Population : Inclusion Criteria: Children between age 18 months to 12 years of age coming to pediatric OPD with 1.Any infection with clinical presentation fitting atleast 2 WHO case definition criteria 2. Symptomatic known HIV+ patients . HIV testing and CD4+ Cell counts were done in all 201 patients Definition of AIDS: HIV positive child satisfying WHO AIDS case definition criteria and HIV positive child with CD4+ cell counts showing severe immunosuppression at that age.
Results: WHO case definition criteria for pediatric AIDS were found to have a Positive Predictive Value of 76.6%. The specificity, sensitivity and Negative Predictive Value were 90%, 85% and 94% respectively. The positive and negative likelihood ratios were 8.5 and 0.16 respectively. As the number of criteria increases and rises beyond 4 (irrespective of composition of 4 criteria i.e. varying number of major and minor) the diagnostic accuracy increases reaching 100% with 6 and 7 criteria. Same proportional increase in accuracy is seen with increase in number of minor criteria >2. WHO case definition criteria for diagnosis of AIDS could not detect 21 symptomatic HIV patients and 8 patients with severe immunosuppression based on CD4 + cell counts.
Conclusions: In resource poor settings instead of going by number of criteria , selective screening of patients with Ho maternal infection, repeated bacterial infection, organomegaly and lymphadenopathy in absence of neoplasia, needs to be evaluated if early HIV infection has to be diagnosed.
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