DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20203455

The value of serum C reactive protein in the assessment of severity of HIV infection among children in a resource limited setting

Otobong C. Udoh, Ofonime T. Dixon umo, Enobong U. Bassey

Abstract


Background: Human immuno-deficiency virus (HIV) infection has devastating impact especially on well-being of children. Management of HIV infected children in resource-limited countries poses significant difficulties. The role of C-reactive protein as a potentially useful/cost-effective tool for assessing severity of HIV infection is yet to be established. The relationship between serum C-reactive protein and severity of HIV infection among children aged 6 months to 12 years was evaluated.

Methods: Authors recruited 85 children each on combined antiretrovirals for ≥3 months, and apparently healthy HIV-negative controls. Severity of HIV infection was assessed by classification into immunologic categories 1, 2, 3 and clinical categories N, A, B, C according to the Centre for Disease Control revised classification system. Enzyme linked immunosorbent assay (ELISA) was used for serum CRP estimation. CD4 count was estimated by flow cytometry. Data analysis was with Statistical Package for Social Sciences version 20.

Results: Response rate was 160 (94.1%) with mean age of participants being 8.50±3.36 years. Male to female ratio was 1.35:1. Lymphadenopathy was the commonest clinical feature in 26 (32.50%) participants, 59 (73.75%) participants were asymptomatic, and 52 (65.00%) were immunologic stage 1. Median serum CRP of HIV infected group and controls were 4.2 (1-13.9) mg/l and 0.5 (0.2-1.9) mg/l respectively. There was an association between Clinical and immunolological stages of infection and levels of serum CRP, p values = 0.001 and 0.002 respectively.

Conclusions: The serum level of CRP may predict the severity of HIV infection among children.


Keywords


C- reactive protein, Cost-effective tool, Children, Severity of HIV infection

Full Text:

PDF

References


UN Aids. UNAIDS fact sheet 2016. Available at: http://www.unaids.org/sites/default/file.

Un Aids J. Fact sheet-latest global and regional statistics on the status of the AIDS epidemic. Geneva: UNAIDS 2017. Available at: http://www.unaids.org/sites/default/file

NACA 2015. Nigeria GARPR. 2015. Available at: https://www.unaids.org/sites/default/files/country/documents/NGA_narrative_report_2015.pdf

Seatle Children’s Hospital. Why HIV causes life-long infection. Science Daily. July 2014. Available at: https://www.sciencedaily.com/releases/2014/07/140715214149.htm.

World Health Organization. Interim WHO clinical staging of HIV/AIDS and HIV/AIDS case definitions for surveillance. African Region (No. WHO/HIV/2005.02). Geneva: World Health Organization. Available at: https://www.who.int/hiv/pub/guidelines/casedefinitions/en/.

Kenneth CG. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. Clini Inf Dis. 1993;17(4):802-10.

Ikpeme EE, Dixon-Umo OT. Disclosure of HIV diagnosis to infected children receiving care in University of Uyo Teaching Hospital, Uyo, Nigeria. J AIDS and HIV Research. 2016 Aug 31;8(7):93-9.

Du Clos TW, Mold C. C-reactive protein. Immunologic research. 2004 Nov 1;30(3):261-77.

Tillett WS, Francis Jr T. Serological reactions in pneumonia with a non-protein somatic fraction of pneumococcus. J Experimental Med. 1930 Sep 30;52(4):561.

Ribeiro MA. Levels of C-reactive protein in serum samples from healthy children and adults in São Paulo, Brazil. Brazilian J Med Biological Res. 1997;30(9):1055-9.

Jahoor F, Abramson S, Heird WC. The protein metabolic response to HIV infection in young children. Am J Clin Nutrit. 2003 Jul 1;78(1):182-9.

Jahoor F, Gazzard B, Phillips G, Sharpstone D, Delrosario M, Frazer ME, et al. The acute-phase protein response to human immunodeficiency virus infection in human subjects. Am J Physiol Endocrinol Metabolism. 1999 Jun 1;276(6):E1092-8.

Noursadeghi M, Miller RF. Clinical value of C-reactive protein measurements in HIV-positive patients. Int J STD and AIDS. 2005 Jun 1;16(6):438.

Tahir A. Correlation Between C-Reactive Protein And Cd4+ Cell Count In Hiv-Infected And Hiv/Ptb Coinfected Patients At The University Of Maiduguri Teaching Hospital (Umth), Maiduguri, Nigeria. Faculty of Internal Medicine. 2011.

Ugwu MC, Okogun GR, Okoye CF, Ekebor KL, Nwafia CJ, Nnona AE, at al. Human serum protein and C-reactive protein levels among HIV infected subjects in Uromi and its environs in Edo, Nigeria. Int J Basic, Applied and Innovative Research. 2016;5(3):74-80.

Drain PK, Kupka R, Msamanga GI, Urassa W, Mugusi F, Fawzi WW. C-reactive protein independently predicts HIV-related outcomes among women and children in a resource-poor setting. AIDS (London, England). 2007 Oct 1;21(15):2067.

Ledwaba, L. Pre-ART levels of inflammation and coagulation markers are strong predictors of death in a South African cohort with advanced HIV disease. PloS one. 2012;7(3):e24243.

Ctr's for Disease Control and Prevention (CDC), and United States of America. Classification system for human immunodeficiency virus (HIV) infection in children under 13 years of age. Morbidity and Mortality Weekly Rep. 1987;15(36):225-30.

Counter PC. Typical steps of particle analysis using Partec cyflow counter. Instrument Operating Manual, Partec GmbH OHO-Hann-str. 2006;32:5-8.

Fru FS, Chiabi A, Nguefack S, Mah E, Takou V, Bogne JB, et al. Baseline demographic, clinical and immunological profiles of HIV-infected children at the Yaounde Gynaeco-Obstetric and Pediatric hospital, Cameroon. Pan African Med J. 2014;17.

Diack AM, Signaté HS, Diagne NG, Ba A, Sylla A, Diouf S, et al. Epidemiological and clinical aspects of paediatric HIV infections in Albert-Royer Paediatric Hospital (Dakar, Senegal). Archives de pediatrie: organe officiel de la Societe francaise de Pediatrie. 2005 Apr;12(4):404-9.

Nwokocha EE. Male-child syndrome and the agony of motherhood among the Igbo of Nigeria. Int J Sociol of the Family. 2007 Apr 1:219-34.

Okechukwu AA, Gambo D, Okechukwu OI. The clinical features of paediatric HIV/AIDS at presentation at the University of Abuja Teaching Hospital, Gwagwalada. Nigerian J Med. 2008 Nov 11;17(4):433-8.

Ogunbosi BO, Oladokun RE, Brown BJ, Osinusi KI. Prevalence and clinical pattern of paediatric HIV infection at the University College Hospital, Ibadan, Nigeria: a prospective cross-sectional study. Italian J Pediatr. 2011 Dec 1;37(1):29.

Obiagwu PN, Hassan-Hanga F, Ibrahim M. Pediatric HIV in Kano, Nigeria. Nigerian J Clin Practice. 2013 Sep 18;16(4).

Shine B, De Beer FC, Pepys MB. Solid phase radioimmunoassays for human C-reactive protein. Clinica chimica acta. 1981 Nov 25;117(1):13-23.

Schlenz H, Intemann T, Wolters M, González-Gil EM, Nappo A, et al. C-reactive protein reference percentiles among pre-adolescent children in Europe based on the IDEFICS study population. Intern J Obesity. 2014 Sep;38(2):S26-31.

Acevedo M, Arnáiz P, Barja S, Bambs C, Berríos X, Guzmán B, et al. Relationship of C-reactive protein to adiposity, cardiovascular risk factors and subclinical atherosclerosis in healthy children. Revista espanola de cardiologia. 2007 Oct 1;60(10):1051-8.

Yoshitsugi H, Robert M. Nakamura. C‐Reactive protein: Current status and future perspectives. J Clin Laboratory Analysis. 1987;1(1):15-27.

Ford ES, Giles WH, Myers GL, Rifai N, Ridker PM, Mannino DM. C-reactive protein concentration distribution among US children and young adults: findings from the National Health and Nutrition Examination Survey, 1999-2000. Clinical Chemistry. 2003 Aug 1;49(8):1353-7.

Shanahan L, Copeland WE, Worthman CM, Erkanli A, Angold A, Costello EJ. Sex-differentiated changes in C-reactive protein from ages 9 to 21: The contributions of BMI and physical/sexual maturation. Psychoneuroendocrinology. 2013 Oct 1;38(10):2209-17.

Wadgera NY, Yadav K, Nagaraja B. C-reactive protein as an early marker of opportunistic infections in HIV. Int J Pharm Bio Sci 2012;3:1194-203.

Ugwu MC, Okogun GR, Okoye CF, Ekebor KL, Nwafia CJ, Nnona AE, et al. Human serum protein and C-reactive protein levels among HIV infected subjects in Uromi and its environs in Edo, Nigeria. Int J Basic, Applied and Innovative Research. 2016;5(3):74-80.

Ogunro PS, Idogun ES, Ogungbamigbe TO, Ajala MO, Olowu OA. Serum concentration of acute phase protein and lipid profile in HIV-1 seropositive patients and its relationship to the progression of the disease. Nigerian Postgraduate Med J. 2008 Dec 1;15(4):219-24.