title: Effect of concomitant HIV infection on presentation and outcome of rotavirus gastroenteritis in Malawian children.
abstract: BACKGROUND
  Rotaviruses represent important causes of severe diarrhoea in early 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 gastroenteritis at the Queen Elizabeth Central Hospital in Blantyre from July, 1997, to June, 1999, were enrolled. Children with rotavirus diarrhoea, with and without HIV infection, were followed up for up to 4 weeks after hospital discharge. Rotavirus disease severity (assessed with a 20-point score), duration of rotavirus shedding, and seroresponse to rotavirus were compared between HIV-infected and HIV-uninfected children.
  
  
  RESULTS
  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 HIV-infected) were enrolled. Rotavirus was detected less frequently among HIV-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 two (4%) HIV-uninfected children (4.66 [1.01-21.51], p=0.05), but shedding was not associated with diarrhoea. Three-quarters of children exhibited a four-fold rise of serum IgG or IgA to rotavirus, which did not vary by HIV status.
  
  
  CONCLUSIONS
  Malawian children with concomitant HIV infection resolved acute rotavirus infections. Rotavirus vaccine safety and immunogenicity in HIV-infected infants should now be determined.
authors.affiliation: Wellcome Trust Research Laboratories, Universities of Malawi and Liverpool, College of Medicine, Blantyre, Malawi. N.A.Cunliffe@liverpool.ac.uk
authors.forename: N A
authors.initials: NA
authors.lastname: Cunliffe
authors.forename: J S
authors.initials: JS
authors.lastname: Gondwe
authors.forename: C D
authors.initials: CD
authors.lastname: Kirkwood
authors.forename: S M
authors.initials: SM
authors.lastname: Graham
authors.forename: N M
authors.initials: NM
authors.lastname: Nhlane
authors.forename: B D
authors.initials: BD
authors.lastname: Thindwa
authors.forename: W
authors.initials: W
authors.lastname: Dove
authors.forename: R L
authors.initials: RL
authors.lastname: Broadhead
authors.forename: M E
authors.initials: ME
authors.lastname: Molyneux
authors.forename: C A
authors.initials: CA
authors.lastname: Hart
mesh_terms: D016009:Chi-Square Distribution; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005759:Gastroenteritis / Q000150:complications* / Q000401:mortality / Q000821:virology; D015658:HIV Infections / Q000150:complications* / Q000401:mortality / Q000821:virology; D015497:HIV-1; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008295:Malawi; D008297:Male; D011379:Prognosis; D012044:Regression Analysis; D012400:Rotavirus Infections / Q000150:complications* / Q000401:mortality; D018709:Statistics, Nonparametric