title: Increased burden of respiratory viral associated severe lower respiratory tract infections in children infected with human immunodeficiency virus type-1.
abstract: OBJECTIVE
  To determine the burden of viral associated severe lower respiratory tract infections (SLRTI) in human immunodeficiency virus-infected (HIV+) and HIV-uninfected (HIV-) urban black South African children.
  
  
  METHODS
  Children with SLRTI aged 2 to 60 months were enrolled between March 1997 and March 1998. Monoclonal antibody immunofluorescent testing was performed on nasopharyngeal aspirates to detect respiratory syncytial virus (RSV), influenza A and B, parainfluenza 1-3, and adenovirus-specific antigens.
  
  
  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 increased for RSV, influenza A/B viruses, parainfluenza 1-3 viruses, and adenovirus 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 <.0001) 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). Children 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.
authors.affiliation: SAIMR/Wits/MRC Pneumococcal Diseases Research Unit, National Institute for Virology, the Department of Paediatrics, Chris Hani-Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: S A
authors.initials: SA
authors.lastname: Madhi
authors.forename: B
authors.initials: B
authors.lastname: Schoub
authors.forename: K
authors.initials: K
authors.lastname: Simmank
authors.forename: N
authors.initials: N
authors.lastname: Blackburn
authors.forename: K P
authors.initials: KP
authors.lastname: Klugman
mesh_terms: D000258:Adenovirus Infections, Human / Q000150:complications; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006801:Humans; D007223:Infant; D007251:Influenza, Human / Q000150:complications; D008297:Male; D018184:Paramyxoviridae Infections / Q000150:complications; D011446:Prospective Studies; D018357:Respiratory Syncytial Virus Infections / Q000150:complications; D012141:Respiratory Tract Infections / Q000150:complications* / Q000821:virology; D012621:Seasons