Children with human immunodeficiency virus infection admitted to a paediatric intensive care unit in South Africa.
BACKGROUND
Early data regarding the outcome of human immunodeficiency virus (HIV)-infected children in paediatric intensive care units (PICU) suggested mortality as high as 100%. Recent studies report mortality of 38%. Survival depends on the indication for admission.


OBJECTIVE
To describe the prevalence, duration of stay, and outcome of HIV-infected patients in a single PICU over a 1-year period. Additional objectives included describing the indications for admission as well as the clinical and laboratory characteristics of HIV-infected infants and children requiring PICU admission.


METHODS
Retrospective chart review of all children with serological proof of HIV admitted to PICU at Tygerberg Children's Hospital from 1 January to 31 December 2003.


RESULTS
Of the 465 patients admitted, 47 (10%) were HIV-infected. For HIV-infected children the median age on admission was 4 months. The median duration of stay was 6 days, significantly longer than for the non-HIV group (p = 0.0001). Fifty-seven percent had advanced clinical and immunological disease. Seventeen died in PICU and four shortly afterwards, poor PICU outcome was significantly associated with HIV status (p = 0.001). Lower total lymphocyte count (p = 0.004) and higher gamma globulin level (p = 0.04) were paradoxically the only findings significantly associated with survival. Acute respiratory failure (ARF) accounted for 76% of admissions, including Pneumocystis jiroveci in 38%. Fifty-one percent had evidence of cytomegalovirus infection.


CONCLUSIONS
HIV-infected children requiring PICU can survive despite the lack of availability of antiretroviral therapy.
Rabie
Helena
H
Department of Paediatrics and Child Health Tygerberg Children's Hospital & Stellenbosch University, South Africa. hrabie@sun.ac.za
de Boer
Anna
A
van den Bos
Suzanne
S
Cotton
Mark F
MF
Kling
Sharon
S
Goussard
Pierre
P
D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000401:mortality*; D015658:HIV Infections / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay; D045363:Pneumocystis carinii / Q000302:isolation & purification / Q000472:pathogenicity*; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology / Q000401:mortality*; D015995:Prevalence; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality*; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis