Aetiology and outcome of pneumonia in human immunodeficiency virus-infected children hospitalized in South Africa

To determine the aetiology and outcome of pneumonia in human immunodeficien cy virus (HIV)-infected children, we prospectively investigated 250 childre n hospitalized with pneumonia who were known or clinically suspected to be HIV-positive, or who required intensive care support in Cape Town, South Af rica. Blood culture, induced sputum or bronchoalveolar lavage, nasopharynge al aspirate and gastric lavage were performed. Of the total, 151 children ( 60.4%) were HIV-infected. Pneumocystis carinii pneumonia (PCP). occurring i n 19 (7.6%) children (15 HIV-positive), was the AIDS-defining infection in 20.3%. The incidence and type of bacteraemia (14.3%) were similar in HIV-po sitive and HIV-negative patients; S. pneumoniae (5%) and S. aureus (2%) wer e the predominant isolates. Sputum or BAL cultures yielded bacteria in 145 of 243 (60%) specimens. viruses were cultured in 37 (15.2%). Bacterial prev alence (including M. tuberculosis in 8%) and anti-microbial resistance did not differ by HIV status except for S. aureus which was more common in HIV- infected children. Thirty-one (20%) HIV-positive and 8 (8%) HIV-negative ch ildren died [RR 1.16 (95% CI 1.05-1.28), p=0.008]; using multiple logistic regression, PCP was the only risk factor for mortality (p = 0.03). Conclusion: In South Africa, PCP is an important AIDS-defining infection in children; bacterial pathogens occur commonly and with a similar prevalence in HIV-positive and HIV-negative children hospitalized for pneumonia. HIV- infected children with pneumonia have a worse outcome than HIV-negative pat ients.