Impact of human immunodeficiency virus type 1 on the disease spectrum of Streptococcus pneumoniae in South African children

Background. HIV-infected children are at increased risk of developing invas ive Streptococcus pneumoniae disease. Objective. To determine the impact of the HIV epidemic on the epidemiology of invasive pneumococcal disease in hospitalized African children. Methods. Children <12 years of age with invasive pneumococcal disease were enrolled between March, 1997, and February, 1999. Results. The seroprevalence of HIV was 64.9% (146 of 225). In children with pneumococcal isolates from serogroups 6, 9, 14, 19 or 23 (pediatric serogr oups), pneumonia and pneumonia with concurrent meningitis was more common i n HIV-infected children (P = 0.03 and P = 0.003, respectively), whereas sep tic shock occurred more of ten in HIV-uninfected children (P = 0.0003). The overall burden of severe invasive pneumococcal disease was 41.7 (95% confi dence interval, 26.5 to 65.6) fold increased in HIV-infected compared with HIV-uninfected children. Reduced susceptibility to penicillin (45.9% vs. 27 .9%, P = 0.009), trimethoprim-sulfamethoxazole (44.5% vs. 19.0%, P = 0.0002 ) and multiple drug resistance was more common in HIV-infected than in HIV- uninfected children (24.0% vs. 6.4%, P = 0.01), respectively. The increased burden of disease and reduced antibiotic susceptibility of pneumococcal is olates in HIV-infected children was because of a heightened susceptibility to disease caused by pediatric serogroups in these children than in HIV-uni nfected children (P = 0.01). Although the case fatality rates did not diffe r between HIV infected and -uninfected children, mortality in HIV-infected children with advanced AIDS (Stage C, 22 of 61; 36.1%) was greater than tha t in children with moderate AIDS (Stage B, 12 of 85; 14.1%, P = 0.002). Conclusions. In children with invasive pneumococcal disease caused by the p ediatric serogroups, HIV-infected children have more antibiotic-resistant i solates and have a different clinical presentation than do HIV-uninfected c hildren.