title: Prevalence and outcome of cytomegalovirus-associated pneumonia in relation to human immunodeficiency virus infection.
abstract: OBJECTIVE
  To investigate the antemortem prevalence and outcome of cytomegalovirus (CMV)-associated pneumonia in African children.
  
  
  METHODS
  A total of 202 children (median age, 3.2 months; 124 human immunodeficiency virus [HIV]-infected, 62%; 87 severely malnourished, 43%) sequentially hospitalized for severe pneumonia were prospectively investigated. In addition to routine microbiologic investigations, respiratory tract secretions and blood were submitted for CMV culture and qualitative and quantitative CMV polymerase chain reaction.
  
  
  RESULTS
  CMV-associated pneumonia was common (28%, 47/169) and more prevalent in HIV-infected than uninfected children (36% vs. 15%; odds ratio [OR], 3.0; 95% confidence interval, 1.3-7.4). CMV-associated pneumonia was more common than Pneumocystis pneumonia (27%) and other viral-associated pneumonia (19%) in HIV-infected children. In-hospital mortality was 25% (51/202) with increased mortality in HIV-infected compared with uninfected children (43/124 [35%] vs. 8/76 [11%]; OR, 4.5; 1.9-11.8). Increased mortality occurred in HIV-infected children with CMV-associated pneumonia (OR, 2.5; 1.04-6.5) but this association was not evident after adjusting for CD4 <15% (adjusted OR, 1.78; 0.6-4.6).
  
  
  CONCLUSIONS
  CMV-associated pneumonia is common and associated with a poor outcome in children with advanced HIV disease. Improved diagnostic testing and increased access to antiviral therapy might improve the outcome of HIV-infected children with CMV-associated pneumonia.
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa. m.zampoli@uct.ac.za
authors.forename: Marco
authors.initials: M
authors.lastname: Zampoli
authors.forename: Brenda
authors.initials: B
authors.lastname: Morrow
authors.forename: Nei-Yaun
authors.initials: NY
authors.lastname: Hsiao
authors.forename: Andrew
authors.initials: A
authors.lastname: Whitelaw
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Zar
mesh_terms: D000349:Africa; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D011024:Pneumonia, Viral / Q000453:epidemiology*; D016133:Polymerase Chain Reaction; D015995:Prevalence; D014776:Virus Cultivation