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Archivos de Pediatría del Uruguay

Print version ISSN 0004-0584On-line version ISSN 1688-1249

Abstract

QUIAN, Jorge et al. Hospitalizaciones de niños infectados por el virus de la inmunodeficiencia humana. Arch. Pediatr. Urug. [online]. 2008, vol.79, n.2, pp.105-112. ISSN 0004-0584.

Introduction: the therapeutic handling of human immunodeficiency virus infection (HIV) by vertical transmission in children has changed in the last years. The implementation of a suitable highly active antiretroviral therapy (HAART) has changed life expectancy and infected children nowadays reach the adult age with a decrease of their morbimortality. These children are hospitalized for different reasons, depending on the local epidemical conditions, socio-economical situation, disease stage and level of treatment adhesion. Acute low respiratory tract infections are the most frequent cause of hospitalization. The etiology is similar to those of uninfected children. When a severe immunological compromise is involved, the etiology also includes some opportunistic infections. Targets: 1) To set the causes and clinical evolution characteristics of hospital admissions of children less than 15 years old infected with HIV by vertical transmission. 2) To describe the nutritional and immunological status of the infected patients and the type of treatment received when hospitalized. Methodical design: a retrospective descriptive study was carried out using the clinical records of children infected with HIV vertically. The patients HIV-AIDS follow-up at the clinic at the Pereira Rossell Hospital were also included. The study was performed from 1990 until 2004. Results: 150 infected patients were included. 15 (10%) did not require hospitalization. The rest had an average of 3 hospital admissions. The three main reasons were: pneumonia (44%), acute child diarrhea (14.2%) and bronchiolitis (4.9%). 43.5% of the admissions corresponded to children under one year of age. Half of the hospitalized children had chronic malnutrition. 37.6% did not present inmunosupression, 16.6% had a moderate inmunosupression and 8% had a severe inmunosupression. In 37.8% the immune state was unknown. 49.7% of the hospitalized children were receiving antiretroviral treatment. One out of 10 hospital admissions required intensive care. 29 children died. Children with inmunosupression had longer hospitalization periods, more admissions to the ICU and a higher mortality. Children less than a year old had longer hospitalization periods and more admissions to the ICU. Discussion: the hospitalization frequency showed a progressive increase from 1990 to 1996. After that period the records show a decreasing tendency which coincides with the introduction of the two-drug therapy in 1995 and the TAE in 1998. The first cause of infected children hospitalization is also the most frequent cause for admissions in general at the Pereira Rossell Hospital. Pneumonia corresponds to 50% of the diagnosis when children leave the hospital. Opportunistic infections are in fourth place; and half of them were extensive or persistent gingivostomatitis. Infected children had a higher percentage of malnutrition than the general hospital population. They stayed longer periods at the hospital and had more admissions to the ICU unit than the pediatric population. One out of 5 children died, and half of them were under 12 months of age. 68% of the deaths happened before the HAART period.

Keywords : HIV; ACQUIRED IMMUNODEFICIENCY SYNDROME; HIV INFECTIONS; HOSPITALIZATION.

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