SERUM TRACE ELEMENTS DISTURBANCES IN HIV INFECTED CHILDREN - PowerPoint PPT Presentation

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SERUM TRACE ELEMENTS DISTURBANCES IN HIV INFECTED CHILDREN

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SERUM TRACE ELEMENTS DISTURBANCES IN HIV INFECTED CHILDREN ... (cases) were assessed using Perkin Elmer Atomic Absorption Spectrophotomer ... – PowerPoint PPT presentation

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Title: SERUM TRACE ELEMENTS DISTURBANCES IN HIV INFECTED CHILDREN


1
SERUM TRACE ELEMENTS DISTURBANCES IN HIV
INFECTED CHILDREN
  • Bharti B, Singh S, Sonia, Attri S, Bhalla AK
  • Advanced Pediatric Center, PGIMER, Chandigarh

2
Introduction Rationale
  • Trace element disturbances frequently underpin
    HIV infection in children and they can escalate
  • immune dysfunction,
  • morbidity and
  • HIV disease progression.

3
Trace elements (Micronutrients) and HIV

4
Rationale
  • This study offers insight into alterations of
    trace elements (Zinc, Copper and Iron ) milieu
    and may prompt better nutritional intervention.

5
Objectives
  • To measure the serum levels of three trace
    elements (zinc, iron and copper) in stable HIV
    infected children.

6
Design Setting
  • Prospective
  • Cross-sectional
  • Setting
  • Pediatric Immunology Clinic at the Advanced
    Pediatric Center, PGIMER Chandigarh

7
Materials Methods
  • Serum zinc (Zn), iron (Fe) and copper(Cu) levels
    in HIV children(cases) were assessed using
    Perkin Elmer Atomic Absorption Spectrophotomer
  • ( Zn Cu) and Dimension AR Autoanalyser (Fe).

8
Methods (contd)
  • Inclusion criteria
  • Children beyond the age of 18 months
    presenting to the Pediatric Immunology clinic of
    Advanced Pediatric Center at PGIMER
  • Exclusion criteria
  • Lack of consent

9
Results
  • 69 stable HIV infected children were enrolled
    during the year 2008 to 2009 hospital.
  • Mean Age(years) 7.9 years (SD 3.6)
  • Range 2 to 18 years
  • Male Female ratio 41

10
Results
  • Route of transmission
  • Perinatally acquired 98
  • Transfusion acquired 2
  • Common clinical manifestations
  • Recurrent or Persistent fever (31)
  • Lymphadenopathy(30)
  • Hepatosplenomegaly (21)
  • Ear infection/pyoderma/skin rash/
  • Oral Thrush/Parotid enlargement (lt10)

11
HIV childrens parent status
  • 20 of the children orphan
  • 30 had a single parent living
  • Out of those with single parent
  • 62 childrens father had expired

12
Nutritional status of the HIV children
  • 14 severely malnourished (lt3 zscore)
  • 25 moderate (-2 to -3z score)
  • 17 mild (-1 to -2 z score)
  • 11 normal

13
Immune status of the children with HIV
  • 11 of the children had CD4 counts lt200
  • suggesting severe immunodeficiency
  • These children were on
  • HAART as per
  • NACO guidelines

14
Levels of the Trace elements
  • Mean Serum Zinc (SD) 114.4 µg/dl (52.0)
  • Normal Serum Zn levels (64-118 µg/dl)
  • Mean Serum Copper (SD) 147.20 µg/dl(51.5)
  • Normal Serum Cu levels(80-150 µg/dl)
  • Serum Iron 92.44 µg/dl(49.9)
  • Normal Serum Fe levels(22-184 µg/dl)

15
age of Patients having low values
  • Serum Zinc -6 of the patients had low values
  • Serum Copper -20 had low values
  • Serum Iron- 17 had low values

16
Serum Copper levels an interesting observation
High values An acute phase reactant
17
Correlation between Trace elements Malnutrition
18
Correlation between Trace elements CD4 counts
19
Correlations between Ser Cu Zn and CD4 counts
  • Serum Cu CD 4 counts
  • Serum Zinc CD4 counts

20
Scatter Plot Serum Iron CD4 counts
21
Serum Copper CD4 counts
22
Correlations between Serum Cu, Zn and Fe level
  • Serum Cu Serum Fe
  • Serum Cu Serum Zn

23
Conclusions
  • 14 of the children were severely malnourished
  • Zn deficiency was observed in 6 children
    whereas Copper and Iron deficiencies were
    reported in 20 and 17 respectively
  • Interestingly 44 of patients had high
    copper levels possibly due to its role as an
    acute phase reactant.

24
Conclusions
  • There was no significant correlation between the
    serum Zinc and copper levels with malnutrition
    and CD4 counts
  • Only significant correlation was with Serum iron
    and severe malnutrition
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