AIDSWEEKLY Plus; Monday, September 15, 2003
Staff Medical Writers

"The WHO [World Health Organization] clinical case definition for pediatric HIV infection has been designed to be used in countries where diagnostic laboratory resources are limited," scientists in the Netherlands explained.

In their study, C.L. Vangend and colleagues at the University of Groningen Hospital "evaluated the WHO case definition to determine whether it is a useful instrument to discriminate between HIV-positive and HIV-negative children."

"In addition, clinical features not included in this case definition were recorded," noted the investigators, who "recorded clinical data from 300 consecutively admitted children in a state hospital in Bloemfontein, South Africa, and tested these children for HIV infection."

"A total of 222 children were included in the study; 69 children (31.1%) were HIV positive," according to the report. "The sensitivity of the WHO case definition in this study was 14.5%, the specificity was 98.6%."

"Apart from weight loss and generalized dermatitis, the signs of the WHO case definition were significantly more often seen in HIV-positive than in HIV-negative children," study data showed. "Of the clinical signs not included in the WHO case definition, marasmus and hepatosplenomegaly especially occurred more frequently in HIV-positive children."

"Based on these findings," the investigators "composed a new case definition consisting of four signs: marasmus, hepatosplenomegaly, oropharyngeal candidiasis, and generalized lymphadenopathy. HIV infection is suspected in a child presenting with at least two of these four signs," they said. "The sensitivity of this case definition was 63.2%, the specificity was 96.0%."

These findings show that "the WHO case definition was not a useful instrument to discriminate between HIV-positive and HIV-negative children, mainly because its sensitivity was strikingly low," the researchers concluded. "The simplified case definition we propose proved to be more sensitive than the WHO case definition (63.2% vs. 14.5%), whilst its specificity remained high."

Vangend and coauthors published their study in the Journal of Tropical Pediatrics (Evaluation of the WHO clinical case definition for pediatric HIV infection in Bloemfontein, South Africa. J Trop Pediatr. 2003 Jun;49(3):143-7.

For more information, contact P.J.J. Sauer, University of Groningen Hospital, Department of Pediatrics, P.O. Box 30-001, NL-9700 RG Groningen, the Netherlands.

Publisher contact information for the Journal of Tropical Pediatrics is: Oxford University Press, Great Clarendon St., Oxford OX2 6DP, UK.

The information in this article comes under the major subject areas of AIDS & HIV and Public Health

This article was prepared by AIDS Weekly editors from staff and other reports.

Reference

van Gend CL, Haadsma ML, Sauer PJ, et al., "Evaluation of the WHO clinical case definition for pediatric HIV infection in Bloemfontein, South Africa", J Trop Pediatr. 2003 Jun;49(3):143-7

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