title: Pneumocystis pneumonia in South African children with and without human immunodeficiency virus infection in the era of highly active antiretroviral therapy.
abstract: BACKGROUND
  Pneumocystis pneumonia (PCP) is a major cause of hospitalization and mortality in human immunodeficiency virus (HIV)-infected African children.
  
  
  OBJECTIVE
  The aim of this study was to investigate the incidence and outcome of PCP in South African children living in a high HIV-prevalence area in the context of a free, available antiretroviral therapy program.
  
  
  METHODS
  Sequential children hospitalized with hypoxic pneumonia were prospectively enrolled from November 2006 to August 2008. Sociodemographic, historical, clinical, and outcome data were collected. A nasopharyngeal aspirate and lower respiratory tract sample (induced sputum or bronchoalveolar lavage) were submitted for PCP immunofluorescence. Lower respiratory tract samples were also investigated for bacterial, mycobacterial, and viral pathogens.
  
  
  RESULTS
  A total of 202 children were enrolled; 124 (61.4%) were HIV-infected; 34 (16.8%) were HIV-exposed but uninfected and 44 (21.8%) were HIV-unexposed. Among HIV-exposed children, 70 (44.3%) had participated in the Prevention of Mother to Child Transmission program, but only 18.4% were taking trimethoprim-sulfamethoxazole prophylaxis. PCP occurred in 43 children (21.3%) of whom 33 (76.7%) were HIV-infected. The case fatality of children with PCP was higher than those without PCP (39.5% vs. 21.4%; relative risk, 1.85; 95% confidence interval, 1.15-2.97; P = 0.01).
  
  
  CONCLUSIONS
  PCP is a common cause of hypoxic pneumonia and mortality in HIV-infected South African infants. Underuse of the Prevention of Mother to Child Transmission program and failure to institute trimethoprim-sulfamethoxazole prophylaxis in HIV-exposed children identified through the program are important obstacles to reducing PCP incidence.
authors.affiliation: Department of Paediatics and Child Health, University of Cape Town, Cape Town, South Africa. brenda.morrow@uct.ac.za
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Morrow
authors.forename: Nei-Yuan
authors.initials: NY
authors.lastname: Hsaio
authors.forename: Marco
authors.initials: M
authors.lastname: Zampoli
authors.forename: Andrew
authors.initials: A
authors.lastname: Whitelaw
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Zar
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D023241:Antiretroviral Therapy, Highly Active; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology / Q000821:virology; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D009296:Nasal Cavity / Q000382:microbiology / Q000821:virology; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology / Q000821:virology*; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology / Q000821:virology; D018709:Statistics, Nonparametric; D016896:Treatment Outcome