prevalence and management of opportunistic infections in hiv infected children

Abstract

BACKGROUND: HIV-infected children are more vulnerable to infections due to their immature and immunologically naive immune system in addition to the immunosuppressive effects of the virus. OBJECTIVE: To establish the prevalence of targeted primary opportunistic infections (OIs) in HIV-infected children seen at the Kenyatta National Hospital (KNH), Comprehensive Care Centre (CCC), and to evaluate their management. METHOD: The study was conducted as a hospital-based cross-sectional study. Incidental sampling was used to obtain 196 patient files of HIV-infected children receiving out-patient care at KNH CCC between March 2008 and April 2008. The files were reviewed for occurrence of targeted opportunistic infections in the past 12 months. Medicines prescribed during the study period were assessed for appropriateness and availability at the KNH CCC pharmacy. This information was entered into a data collection form and then analysed using the Statistical Package for Social Sciences (SPSS) software. RESULTS: Overall, 144 infection episodes occurred among the study participants. The three most common events were bacterial pneumonia (30.1%), tuberculosis (22.4%) and oral candidiasis (12.2%). Prevalence of tuberculosis and bacterial pneumonia correlated significantly with duration on HAART and WHO Stage. A total of 1030 drug-prescriptions were reviewed. Antiretrovirals (44.6%), antibiotics (25.4%) and vitamin supplements (18.5%) were the most prescribed drugs. 112 prescription errors were identified which were: wrong dosage (105), inappropriate choice (4), and contraindicated medicines (3). The majority (86.9%) of prescribed drugs were available at the CCC Pharmacy. Essential medicines that were not available included: anti-tuberculosis drugs, haematinics and anthelmintics. CONCLUSION: The prevalence of OIs in HIV-infected children varies with pathogen, duration on HAART and WHO Stage. Medicines are generally rationally prescribed to the children. The most common prescription errors were incorrect dosage of cotrimoxazole and antiretrovirals. Most of the medicines prescribed were available at the CCC pharmacy. RECOMMENDATION: Prescribers and pharmacists should work closely to develop appropriate strategies to address dosing errors particularly of cotrimoxazole and antiretrovirals which are the most commonly prescribed medicines.