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Journal of Tropical Pediatrics Advance Access originally published online on January 15, 2009
Journal of Tropical Pediatrics 2009 55(4):238-243; doi:10.1093/tropej/fmn114
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© The Author [2009]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Endoscopy Findings in HIV-Infected Children from Sub-Saharan Africa

M. L. Cookea,b, E. A. Goddarda and R. A. Browna

aSchool of Child and Adolescent Health, University of Cape Town, Red Cross Children's Hospital, Cape Town, South Africa
bDepartment of Paediatrics and Child Health, University of Stellenbosch, Tygerberg Children's Hospital, Cape Town, South Africa

Correspondence: Dr M. L. Cooke, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Stellenbosch, P.O. Box 19063, Tygerberg, 7505, South Africa. Tel.: +27 21 938 9506; Fax: +27 21 938 9138; E-mail <lcooke{at}sun.ac.za>.


  Abstract

Background: The causes of persistent gastro-intestinal symptoms in HIV-infected children from sub-Saharan Africa remain poorly documented.

Methods: The clinical, radiological and endoscopic findings of all HIV-infected children who underwent upper GI endoscopy at Red Cross Children's Hospital, Cape Town, South Africa, from February 2003 to October 2005 were documented.

Results: Twenty-six HIV-infected children underwent endoscopy; median age 1 year (range: 0.17–10.9 years). The majority had advanced HIV disease; 18 (69%) were WHO Stage 4; median CD4 10.7% (range: 1–39.8%). Presenting symptoms included persistent vomiting (18), dysphagia (4) and GIT bleed (6). Observational and histological findings showed poor correlation. Pathogens were identified in 10 children: cytomegalovirus infection in seven (two with cryptosporidium co-infection), Candida in two, Helicobacter pylori in one. Age and CD4 count were not associated with the pathogens. Endoscopy findings influenced clinical management in 21 (81%) cases.

Conclusion: Upper-GI endoscopy identified a diverse spectrum of disease and provided information that would be clinically relevant to most HIV-infected children with upper gastro-intestinal symptoms.


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