To the Editor: HIV infected children are more likely than adults to be hospitalized with bacterial and viral infections [1]. Successful implementation of anti-retroviral therapy (ART) has led to better management of opportunistic infections (OIs) in these children [2]. This cross-sectional study on 137 children enrolled in the ART center of GMCH was conducted to determine the prevalence and risk factors associated with opportunistic infections.

Younger children (<10 y) had a higher prevalence of OIs (90.9%) compared to older children (66.7%). Fever was the commonest clinical presentation. The commonest opportunistic infection was bacterial pneumonia (15.3%), followed by oral candidiasis (10.2%) and tuberculosis (7.1%). There was a very significant statistical correlation between incidence of OIs and advancing WHO stage (p <0.001). The association between duration of ART and incidence of opportunistic infections was also found to be statistically significant (p <0.05).

Diarrheal illnesses, weight loss and protein energy malnutrition (PEM) were common reasons for outpatient visits in these children. The clinical spectrum in our study points towards a more generalized set of symptoms rather than AIDS defining infections. Dhaka et al., in their study, have reported similar findings [3]. AIDS defining OIs in our study include 2 cases of cryptococcal meningitis, 1 case of Kaposi sarcoma, 5 cases of P. jiroveci and 4 cases of cytomegalovirus (CMV) retinitis. Contrary to western countries, P. jiroveci is not as common in our country due to the likelihood of better coverage of cotrimoxazole prophylaxis [4]. Skin infections included severe cases of scabies, tinea and non-specific eczema.

Our study re-affirms that the management of HIV does not just involve ART, but also in screening for and managing OIs. It would be prudent to keep a high index of suspicion for HIV in children presenting with recurrent respiratory infections, failure to thrive, oral candidiasis, chronic or persistent diarrhea, and skin infections with unusual severity.