CHARACTERISTICS OF ACUTE PNEUMONIA IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN AND ASSOCIATION WITH LONG-TERM MORTALITY RISK

Objective. To describe the epidemiologic, clinical, radiologic, labora tory and treatment characteristics of acute pneumonia and its associat ion with mortality in HIV-infected children. Methods. Data were collec ted during a trial of intravenous immunoglobulin (IVIG) for infection prophylaxis (1988 to 1991); CD4(+) percentage was measured and HIV RNA was assessed on stored sera collected at baseline and every 3 months. Mortality was recorded during the trial and updated through 1996. All reported physician-diagnosed pneumonia episodes underwent blinded rev iew for trial endpoint classification as acute (new radiologic finding s and presence of clinical symptoms) or nonacute. Results. On blinded clinical trial endpoint review of all reported pneumonia episodes (n = 281), only 47% were classified as acute. One hundred thirty-one episo des of acute pneumonia were reported in 93 children (47 in 31 IVIG and 84 in 62 placebo patients, P < 0.01). The incidence of acute pneumoni a was 24 episodes per 100 patient years. Findings associated with an a cute bacterial process were uncommon (leukocytosis greater than or equ al to 15 000/mm(3) in 21% and fever greater than or equal to 103 degre es F in 32% of episodes). Multiple acute episodes occurred in 34% of t he children and were associated with increased risk of mortality in a univariate analysis (risk ratio, 2.1; 95% confidence interval, 1.3 to 3.4, P = 0.002), but in a multivariate model only baseline HIV RNA cop y number and CD4(+) percentage remained independently associated with mortality (relative risk, 2.0 and 1.4, respectively, P < 0.001). Concl usion. Acute pneumonia was a common occurrence in HIV-infected childre n and was associated with long term mortality risk. Multiple episodes of acute pneumonia likely represent a marker of progressive disease an d immunologic dysfunction rather than being causally associated with i ncreased long term mortality.