Clinical and endocrinologic manifestations in perinatally human immunodeficiency virus type 1--Infected children aged 5 years or older
P. Lepage, P. Van de Perre, G. Van Vliet, F. Nsengumuremyi, C. Van Goethem, P. Kestelyn, P. Msellati and D. G. Hitimana
Department of Pediatrics, Centre Hospitalier de Kigali, Rwanda.
Sixteen human immunodeficiency virus type 1 (HIV-1)-seropositive children
aged 5 to 12 years (nine girls and seven boys), born to HIV-1-infected
mothers, were diagnosed between 1984 and 1987 in Kigali, Rwanda. They were
compared with a group of age- and sex-matched HIV-1-seronegative children
consecutively selected from the outpatient department. Two subjects were
asymptomatic. Chronic cough was the most frequent symptom (seven of 16
patients). The most common signs were short stature (12 of 16 patients),
low weight for age (seven of 16 patients), chronic parotitis (eight of 16
patients), persistent generalized lymphadenopathy (seven of 16 patients),
and pulmonary tuberculosis (four of 16 patients). Lymphoid interstitial
pneumonitis was diagnosed on radiologic grounds in five of 16 patients.
Evidence of perivasculitis in the fundus was noted in three of 16 patients.
Two children died during the study period (mean duration of follow-up, 40
months; range, 27 to 62 months); none of the other children had
life-threatening infection or loss of developmental milestones. Immunologic
assessment in the 16 children revealed high levels of IgG, decreased
CD4+/CD8+ ratio, and skin test anergy. Endocrinologic investigations
revealed normal thyroid function and normal basal human growth hormone
levels but low basal insulinlike growth factor I levels (0.21 +/- 0.07 vs
0.44 +/- 0.20 U/mL for controls). In Kigali, perinatally HIV-1-infected
children surviving beyond 5 years of age often present with moderate signs
and symptoms, principally pulmonary involvement, chronic parotitis, and
persistent generalized lymphadenopathy. Short stature is the major clinical
manifestation in these patients and may be due, in part, to low growth
hormone secretion rather than to malnutrition.
