title: Lower respiratory tract infections associated with influenza A and B viruses in an area with a high prevalence of pediatric human immunodeficiency type 1 infection.
abstract: BACKGROUND
  Despite the high burden of pediatric HIV-1 infection in developing countries, there are few data on the clinical course of influenza virus-associated lower respiratory tract infection (LRTI) in these children.
  
  
  OBJECTIVE
  To define and compare the clinical course of HIV-1-infected and -uninfected African children hospitalized with influenza virus associated severe LRTI.
  
  
  METHODS
  Children with severe LRTI were prospectively recruited between March, 1997, and March, 1999, as part of a broader study evaluating the etiology and outcome of this condition in hospitalized HIV-1-infected and -uninfected children. The results of children in whom influenza A or B virus was identified by immunofluorescent antibody staining after shell vial culture are reported. Viruses isolated were typed by hemagglutination inhibition assays.
  
  
  RESULTS
  Twenty-five (21.6%) of the 116 children hospitalized with severe LRTI in whom influenza A or B virus was identified were HIV-1-infected. HIV-1-infected children were older than uninfected children (mean age +/- SD 17.4 +/- 10.8 months vs. 10.2 +/- 8.9 months; P = 0.002). HIV-1-infected children were more likely to have an underlying medical illness (in addition to HIV-1 infection) predisposing them to more severe LRTI (32.0% vs. 13.2%; P = 0.03). HIV-infected children were also more likely to have indirect evidence of bacterial coinfection, including chest radiographic evidence of confluent alveolar consolidation (78.9% vs. 35.1%, P = 0.006), and were less likely be wheezing (8.0% vs. 31.9%, P = 0.01). However, there was no difference in the clinical outcome of HIV-1-infected and -uninfected children. The duration of hospitalization [median (range) 5 (2 to 33) days vs. 4 (0 to 21) days, P = 0.08] and the mortality rates (8.0% vs. 2.2%, P = 0.20) were similar between HWV-1-infected and -uninfected children.
  
  
  CONCLUSIONS
  HIV-1-infected children hospitalized with severe LRTI associated with influenza virus have an outcome similar to that of HIV-1-uninfected children even in the absence of antiretroviral or anti-influenza virus treatment.
authors.affiliation: University of the Witwatersrand/Medical Research Council Pneumococcal Diseases Rearch Unit, Johannesburg, South Africa.
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
authors.forename: Nini
authors.initials: N
authors.lastname: Ramasamy
authors.forename: Terry G
authors.initials: TG
authors.lastname: Bessellar
authors.forename: Haroon
authors.initials: H
authors.lastname: Saloojee
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
mesh_terms: D002675:Child, Preschool; D015897:Comorbidity; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1 / Q000472:pathogenicity*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009980:Influenza A virus / Q000472:pathogenicity*; D009981:Influenza B virus / Q000472:pathogenicity*; D007251:Influenza, Human / Q000150:complications*; D008297:Male; D011379:Prognosis; D012141:Respiratory Tract Infections / Q000821:virology*; D012720:Severity of Illness Index; D013019:South Africa; D016019:Survival Analysis; D016896:Treatment Outcome