HIV infected children are at increased risk for acute opportunistic infections (OI) as a result of impaired immunity. Acute phase reactants such as, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), are frequently used as an adjunct test in the evaluation of OI. Elevated immunoglobulin G (IgG) can cause ESR to be elevated. The objective of the study was to determine if CRP is better than ESR as an adjunctive test in the evaluation of acute OI in HIV infected children. ESR, CRP, and IgG levels were measured in two groups of HIV infected children. First group included 34 children with confirmed acute OI (cases) and the second group included 45 children without evidence of acute OI (controls). Thirty (88%) cases had an elevation of IgG and all of them had elevated ESR. Twenty-four (80%) cases had elevation of both ESR and CRP. Forty-two (93%) controls had elevation of IgG. ESR was elevated in 30 (57%) and CRP in 3 (2%) controls. McNemar's test for comparing correlated proportions was used to compare ESR and CRP specificites, sensitivities, and total percent of patients correctly identified with regard to acute infection status within each patient group. The specificity for ESR and CRP was 33.3% and 93.3% respectively, (p=0.0001) and the positive predictive value was 52.4% for ESR and 90.3% for CRP. The overall percentage of cases or controls correctly identified as having an acute infection were 60.8% for ESR and 88.6% for CRP respectively,(p=0.0001).
Our data suggest that CRP is more specific than ESR in the evaluation of acute OI in HIV infected children.
