TRENDS AND RISK-FACTORS FOR HIV-1 SEROPOSITIVITY AMONG OUTPATIENT CHILDREN, KINSHASA, ZAIRE

To investigate recent trends in pediatric HIV-1 infection and the early impact of a blood screening program begun in one hospital in 1987 in Kinshasa, Zaire, we evaluated 1110 consecutive children seen in the pediatric emergency ward of the city's largest hospital in November 1988. The HIV-1 seroprevalence was 5.0%, not significantly higher than the rate of 3.8% found in 1986 (P = 0.2). The seropositivity rate was bimodally distributed; children < 6 months of age had a higher rate (12.6%) than children 6-11 months old (1.9%; OR = 7.6; P < 0.0001) and children 1-13 years old (4.1%; OR = 3.4; P < 0.0001). Seropositive children greater-than-or-equal-to 1 year of age were more likely than seronegative children to be anemic and to have signs of malnutrition. A previous blood transfusion was associated with HIV-1 seropositivity among children greater-than-or-equal-to 1 year of age (OR = 5.4. P < 0.0005), but not among younger children. Fifty-two per cent of seropositive children greater-than-or-equal-to 1 year of age had received a transfusion (etiological fraction = 42%). The association with seropositivity was higher for those who had received a transfusion before 1987 than for those who had received a transfusion since 1987 (OR = 4.8, P = 0.01). These findings suggest a relatively stable, high pediatric HIV-1 seroprevalence in Kinshasa and a decreased but continued risk of transfusions. Expansion of currently limited blood transfusion screening programs, and the development of new strategies for limiting transfusions and preventing severe anemia, are needed.