Effect of concomitant HIV infection on presentation and outcome of rotavirus gastroenteritis in Malawian children

Background Rotaviruses represent important causes of severe diarrhoea in ea rly childhood. We examined the effect of HIV infection on the presentation and outcome of rotavirus gastroenteritis in Malawian children. Methods Children younger than 5 years who were treated for acute gastroente ritis at the Queen Elizabeth Central Hospital in Blantyre from July, 1997, to June, 1999, were enrolled. Children with rotavirus diarrhoea, with and w ithout HIV infection, were followed up for up to 4 weeks after hospital dis charge. Rotavirus disease severity (assessed with a 20-point score), durati on of rotavirus shedding, and seroresponse to rotavirus were compared betwe en HIV-infected and HIV-uninfected children. Findings 786 inpatients (median age 8 months, 271 [34%] of whom were HIV-1- infected) and 400 outpatients (median age 9 months, 65 [16%] of whom were H IV-infected) were enrolled. Rotavirus was detected less frequently among HI V-infected children (102 of 336 [30%]) than among HIV-uninfected children ( 348 of 850 [41%], (relative risk 0.71 [95% CI 0.53-0.87], p=0.0007). There were no differences in rotavirus disease severity for hospitalised children with and without HIV infection, but HIV-infected children were more likely to die during follow-up (11/50 [22%]) than HIV-uninfected children (0/61, p<0.0001). Of 29 HIV-infected and 45 HIV-uninfected children who completed follow-up, six (21%) HIV-infected children shed rotavirus, compared with tw o (4%) HIV-uninfected children (4.66 [1.01-21.51], p=0.05), but shedding wa s not associated with diarrhoea. Three-quarters of children exhibited a fou r-fold rise of serum IgG or lgA to rotavirus, which did not vary by HIV sta tus. Interpretation. Malawian children with concomitant HIV infection resolved a cute rotavirus infections. Rotavirus vaccine safety and immunogenicity in H IV-infected infants should now be determined.