Increased burden of respiratory viral associated severe lower respiratory tract infections in children infected with human immunodeficiency virus type-1

Abstract

Objectives: To determine the burden of viral associated severe lower respiratory tract infections (SLRTI) in human immunodeficiency virus–infected (HIV+) and HIV-uninfected (HIV–) urban black South African children. Methods: Children with SLRTI aged 2 to 60 months were enrolled between March 1997 and March 1998. Monoclonal antibody immunofluorescent testing was performed on nasopharyngeal aspirates to detect respiratory syncytial virus (RSV), influenza A and B, parainfluenza 1-3, and adenovirus-specific antigens. Results: Of the 990 children studied, 44.6% were HIV+. The estimated burden of disease of viral associated SLRTI in children under 2 years was increased for RSV, influenza A/B viruses, parainfluenza 1-3 viruses, and adenovirus in children who were HIV+ compared with children who were HIV– (P <.001). Viral pathogens, however, were identified less frequently (15.7% vs 34.8%, P < 10–5) and bacterial pathogens more frequently (12.5% vs 5.8%, P <.0001) in children who were HIV+ than in children who were HIV– and had SLRTI. The seasonal peak for RSV in late summer–early autumn observed in children who were HIV– was less evident in children who were HIV+ (P =.02). Children who were HIV+ and had virus-associated SLRTI had a higher mortality rate (7.5%) than did children who were HIV– (0%, P < 10–3). Conclusions: The contribution of viral associated SLRTI differs between HIV+ and HIV– children. In HIV+ children in South Africa, RSV isolation is not limited by season. (J Pediatr 2000;137:78-84)