PROSPECTIVE, CONTROLLED-STUDY OF THE OUTCOME OF HUMAN IMMUNODEFICIENCY VIRUS-1 ANTIBODY-POSITIVE CHILDREN ADMITTED TO AN INTENSIVE-CARE UNIT

Objective: Intensive care resources are both scarce and costly in Sout h Africa. We set out to ascertain whether human immunodeficiency virus (HIV) status affects the spectrum of disease and the prognosis in chi ldren treated in pediatric intensive care units (ICUs). Design: A pros pective, case-controlled study. Setting: The pediatric ICU at King Edw ard VIII Hospital, Durban, South Africa.Patients: HIV positive cases w ere classified as ''acquired immunodeficiency syndrome,'' ''symptomati c HIV,'' and ''HIV-unrelated diseases.'' Controls were matched for age , race, gender, severity of disease, and admitting diagnosis. Measurem ents and Main Results: The clinician was blinded to the serostatus of patients. Informed consent and Ethics Committee approval were obtained for HIV testing and the study. Outcome measures were the duration of intermittent positive-pressure ventilation and ICU stay, maximum venti latory requirements, infectious complications, and mortality. There we re 11 cases of acquired immune deficiency syndrome (AIDS), 24 cases of symptomatic HIV, and 13 cases of HIV-unrelated diseases. Mortality ra tes for the three groups were as follows: 100% in patients with AIDS c ompared with 55% in their controls (p < .01); 38% in patients with sym ptomatic HIV and 46% in controls; and 54% in patients with HIV-unrelat ed disease as against 46% in controls. Cytomegalovirus and Pneumocysti s carinii infections were significantly in creased (p < .01, p < .002, respectively) in patients with AIDS as compared with controls. Outcom e measures were similar in those patients with symptomatic HIV and tho se patients with HIV-unrelated diseases, as compared with their respec tive controls. Conclusions: Outcome in children with AIDS admitted to the pediatric ICU was significantly worse than the outcome in HIV-unin fected children. However, the number of AIDS patients studied was smal l. HIV antibody-positive children without AIDS do as well as uninfecte d controls. Ethics committees in resource-constrained countries may be assisted by such data when making difficult decisions on the admissio ns of HIV-infected patients to pediatric ICU facilities.