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

Objectives: To determine the burden of viral associated severe lower respir atory tract infections (SLRTI) in human immunodeficiency virus-infected (HI V+) and HIV-uninfected (HIV-) urban black South African children. Methods: Children with SLRTI aged 2 to 60 months were enrolled between Marc h 1997 and March 1998. Monoclonal antibody immunofluorescent testing was pe rformed on nasopharyngeal aspirates to detect respiratory syncytial virus ( RSV), influenza A and B, parainfluenza 1-3, and adenovirus-specific ant;gen s. 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 increas ed for RSV, influenza A/B viruses, parainfluenza 1-3 viruses, and adenoviru s 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 <.00 01) 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). Childre n 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.