Paediatric Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency
Syndrome (AIDS) remain a significant health care challenge in South Africa. Oral
health and coagulation are only two of the many problems experienced by HIV
positive paediatric patients.
This research report began with an observation that known HIV positive paediatric
patients bled more than known HIV negative paediatric patients or those with
unknown HIV status while undergoing dental extractions at Charlotte Maxeke
Johannesburg Academic Hospital. The observation prompted a prospective,
contextual, descriptive study looking at the coagulation profile (platelet count and
thromboelastogram (TEG) profile (reaction time (r-time), clot formation time (Ktime),
alpha angle (α-angle) and maximum amplitude (MA)), CD4 counts and
percentages and observed clinical bleeding in HIV negative, HIV positive not on
antiretroviral treatment (ARVs) and HIV positive on ARVs paediatric patients
presenting for dental extraction.
Over a two year period 47 HIV negative, 12 HIV positive not on ARVs and 17 HIV
positive on ARVs paediatric patients were enrolled in the study using a
consecutive, convenience sampling method. Each paediatric patient was given a
standard inhalational general anaesthetic using sevoflurane and during
intravenous cannulation the researcher drew blood from each child for analysis. A
senior dentist from the Department of Paediatric Dentistry assessed bleeding in all
cases. The data obtained for each of the three study groups was compared using a oneway
analysis of variance followed by pair wise comparison using the Bonferroni
adjustment to address multiplicity. To deal with the big standard deviations and
skewed data a one-way analysis of variance for ranks tested for differences
between the groups. No statistically significant differences were found when
comparing the groups for platelet count (p = 0.2087), TEG r-time (p = 0.4738),
TEG K-time (p = 0.6967), TEG α-angle (p = 0.7948) or TEG MA (p = 0.2982).
There was a statistically significant difference between the HIV negative and HIV
positive not on ARVs groups (p = 0.000 and 0.004) and HIV positive on ARVs and
HIV positive not on ARVs groups (p = 0.000 and 0.001) when comparing CD4
count and percentage.
Patient groups were compared with respect to bleeding complications using the
Fisher’s exact test. There was no statistically significant difference in observed
bleeding between the three groups of paediatric patients. The entire HIV positive
group was then compared for bleeding, and using the Welch t-test, adjusting for
unequal variances it was found that there was statistically, significantly more
bleeding in the HIV positive children with lower CD4 counts regardless of
treatment with ARVs (p = 0.0129). These results were also confirmed using the
Wilcoxon rank-sum test (p = 0.0335).
Although this study showed statistically significant bleeding in HIV positive
paediatric patients with lower CD4 counts, the tests of coagulation used in the
study were unable to define the underlying pathogenesis. Further research into
coagulation in HIV positive paediatric patients is needed.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/12684 |
| Date | 24 April 2013 |
| Creators | Zeijlstra, Anne Elisabeth |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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