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Title: Case definitions for paediatric AIDS: the Zambian experience.
Author: Chintu C, Malek A, Nyumbu M, Luo C, Masona J, DuPont HL, Zumla A.
Journal: Int J STD AIDS; 1993; 4(2):83-5. PubMed ID: 8476970.
Abstract:
For the purpose of surveillance of the acquired immunodeficiency syndrome (AIDS) in developing countries, the World Health Organization (WHO) has recommended criteria for the clinical case definition of AIDS in adults and children. In a preliminary examination of children in Zambia a number of patients with obvious AIDS did not fit the published WHO case definition for paediatric AIDS. Based on this the Zambia National AIDS Surveillance Committee designed local criteria for the clinical case definition of paediatric AIDS. We compared the Zambian criteria with the WHO criteria for the diagnosis of paediatric AIDS by studying 134 consecutively admitted children to one of the paediatric wards at the University Teaching Hospital in Lusaka. Twenty-nine of the patients were HIV-1 seropositive and 105 were HIV-1 seronegative. Among the 29 HIV-seropositive patients, the Zambian criteria identified 23, and the WHO criteria identified 20 children as having AIDS. The 105 HIV-seronegative children were classified as having AIDS in 9 cases by the Zambian criteria and in 38 cases by the WHO criteria. These results give the Zambian criteria for the diagnosis of AIDS a sensitivity of 79.3%, a specificity of 91.4% and a positive predictive value of 86.8% compared to a sensitivity of 69%, specificity of 64% and a positive predictive value of 38% for the WHO criteria. The current WHO criteria are inadequate for the diagnosis of paediatric AIDS. The need to refine the WHO criteria for the diagnosis of paediatric AIDS is discussed. Medical professionals in countries with only poor and limited laboratory facilities often must diagnose diseases solely upon the basis of clinical manifestations. In an attempt to facilitate the surveillance of AIDS in developing countries, the World Health Organization (WHO) recommended criteria for the clinical case definition of AIDS in adults and children. Preliminary examination of children in Zambia, however, found that a number of patients with obvious AIDS did not fit the published WHO case definition for pediatric AIDS. The Zambia National AIDS Surveillance Committee therefore subsequently designed local criteria for the clinical case definition of pediatric AIDS. This paper presents findings from a comparison of the Zambian criteria with the WHO criteria for the diagnosis of pediatric AIDS. Major signs of pediatric AIDS in the WHO clinical case definition are weight loss or abnormally slow growth, chronic diarrhea of more than one month's duration, and prolonged fever of more than one month's duration, while the major signs in the Zambian clinical criteria are recurrent fever of at least one month's duration, recurrent oropharyngeal candidiasis, and recurrent respiratory infections. 134 consecutively admitted children to one of the pediatric wards at the University Teaching Hospital in Lusaka were studied. The FUJIREBIO particle agglutination test, ELISA, and Western blot tests found 29 patients to be HIV-1-seropositive and 105 to be HIV-1-seronegative. Among the 29 HIV-seropositive patients, the Zambian criteria identified 23 and the WHO criteria identified 20 children as having AIDS. The 105 HIV-seronegative children were classified as having AIDS in 9 cases by the Zambian criteria and in 38 cases by the WHO criteria. These results indicate a sensitivity, specificity, and positive predictive value of 79.3%, 91.4%, and 86.8%, respectively, for the Zambian criteria for the diagnosis of AIDS, compared to 69%, 64%, and 38%, respectively, for the WHO criteria. The authors conclude that current WHO criteria are inadequate for the diagnosis of pediatric AIDS, and discuss the need to refine the WHO criteria for that diagnosis.

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