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HIV seropositivity in hospitalized children with high clinical likelihood of AIDS.

A study was undertaken between August 1997 and February 1999 in India to determine the prevalence of HIV infection in hospitalized children with clinically high likelihood of AIDS. These children in the age group of 3 months-12 years were selected on the basis of the WHO clinical criteria for diagnosis of AIDS in children in developing countries. Inclusion criteria were presence of the following: 3 major; 2 major and 2 minor; and 2 major and 1 minor criteria. Overall the results of this study show that of the 122 children screened only 1 child was seropositive. This was a 2- year old male child admitted with failure to thrive fever for more than 1 month and oropharyngeal candidiasis. As per WHO classification this patient had 2 major and 1 minor criteria for diagnosis of AIDS. Hence this study questions the sensitivity and specificity of the criteria. It is noted that in areas where seroprevalence is low application of the WHO criteria without establishing seropositivity will lead to an unacceptable high false positive diagnosis. However with < 1% seropositivity it is concluded that the presence of HIV infection in the area is low. Thus multicentric studies are required to evaluate the effectiveness and to suggest modifications to these criteria so as to increase their sensitivity in the diagnosis of AIDS.