title: Impact of human immunodeficiency virus type 1 infection on the epidemiology and outcome of bacterial meningitis in South African children.
abstract: OBJECTIVE
  To define the impact that the human immunodeficiency virus type 1 (HIV-1) epidemic has had on the burden and outcome of bacterial meningitis in an area with a high prevalence of pediatric HIV-1 infection.
  
  
  METHODS
  Children less than 12 years of age with proven or suspected bacterial meningitis were enrolled in this study between March 1997 and February 1999, and their hospital records were retrospectively reviewed for clinical data.
  
  
  RESULTS
  Sixty-two (42.2%) of the 147 children tested for HIV-1 infection were infected. Streptococcus pneumoniae (Pnc) exceeded Haemophilus influenzae type b (Hib) as the most important cause of meningitis in HIV-1-infected (74.2% vs. 12.9%, respectively) compared with uninfected children (29.4% vs. 42.3%, respectively, P less than 10(-5)). The estimated relative risk of Pnc meningitis was greater in HIV-1-infected than in uninfected children under 2 years of age (relative risk [RR] = 40.4; 95% confidence intervals [CI] = 17.7-92.2). Overall, HIV-1-infected children had a higher rate of mortality than uninfected children (30.6% vs. 11.8%, respectively, P = 0.01), and in particular, HIV-1-infected children with Pnc meningitis (60.8% vs. 36.0%, respectively, P = 0.04) had a poorer outcome.
  
  
  CONCLUSIONS
  Streptococcus pneumoniae has exceeded Hib as the most important pathogen causing bacterial meningitis in HIV-1-infected compared with uninfected children. Effective vaccination against Hib and Pnc should be evaluated to reduce the overall burden of bacterial meningitis in HIV-1-infected children.
authors.affiliation: MRC/SAIMR/Wits Pneumococcal Diseases Research Unit, Chris Hani-Baragwanath Hospital, Johannesburg, South Africa. shabirm@mail.saimr.wits.ac.za
authors.forename: S A
authors.initials: SA
authors.lastname: Madhi
authors.forename: A
authors.initials: A
authors.lastname: Madhi
authors.forename: K
authors.initials: K
authors.lastname: Petersen
authors.forename: M
authors.initials: M
authors.lastname: Khoosal
authors.forename: K P
authors.initials: KP
authors.lastname: Klugman
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D002675:Child, Preschool; D005260:Female; D015497:HIV-1; D006801:Humans; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies