title: Epidemiology of respiratory syncytial virus-associated acute lower respiratory tract infection hospitalizations among HIV-infected and HIV-uninfected South African children, 2010-2011.
abstract: BACKGROUND
  There are limited data on respiratory syncytial virus (RSV) infection among children in settings with a high prevalence of human immunodeficiency virus (HIV). We studied the epidemiology of RSV-associated acute lower respiratory tract infection (ALRTI) hospitalizations among HIV-infected and HIV-uninfected children in South Africa.
  
  
  METHODS
  Children aged <5 years admitted to sentinel surveillance hospitals with physician-diagnosed neonatal sepsis or ALRTI were enrolled. Nasopharyngeal aspirates were tested by multiplex real-time polymerase chain reaction assays for RSV and other viruses. Associations between possible risk factors and severe outcomes for RSV infection among HIV-infected and uninfected children were examined. The relative risk of hospitalization in HIV-infected and HIV-uninfected children was calculated in 1 site with population denominators.
  
  
  RESULTS
  Of 4489 participants, 4293 (96%) were tested for RSV, of whom 1157 (27%) tested positive. With adjustment for age, HIV-infected children had a 3-5-fold increased risk of hospitalization with RSV-associated ALRTI (2010 relative risk, 5.6; [95% confidence interval (CI), 4.5-6.4]; 2011 relative risk, 3.1 [95% CI, 2.6-3.6]). On multivariable analysis, HIV-infected children with RSV-associated ALRTI had higher odds of death (adjusted odds ratio. 31.1; 95% CI, 5.4-179.8) and hospitalization for >5 days (adjusted odds ratio, 4.0; 95% CI, 1.5-10.6) than HIV-uninfected children.
  
  
  CONCLUSIONS
  HIV-infected children have a higher risk of hospitalization with RSV-associated ALRTI and a poorer outcome than HIV-uninfected children. These children should be targeted for interventions aimed at preventing severe RSV disease.
authors.affiliation: Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Moyes
authors.forename: Cheryl
authors.initials: C
authors.lastname: Cohen
authors.forename: Marthi
authors.initials: M
authors.lastname: Pretorius
authors.forename: Michelle
authors.initials: M
authors.lastname: Groome
authors.forename: Anne
authors.initials: A
authors.lastname: von Gottberg
authors.forename: Nicole
authors.initials: N
authors.lastname: Wolter
authors.forename: Sibongile
authors.initials: S
authors.lastname: Walaza
authors.forename: Sumayya
authors.initials: S
authors.lastname: Haffejee
authors.forename: Meera
authors.initials: M
authors.lastname: Chhagan
authors.forename: Fathima
authors.initials: F
authors.lastname: Naby
authors.forename: Adam L
authors.initials: AL
authors.lastname: Cohen
authors.forename: Stefano
authors.initials: S
authors.lastname: Tempia
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kahn
authors.forename: Halima
authors.initials: H
authors.lastname: Dawood
authors.forename: Marietjie
authors.initials: M
authors.lastname: Venter
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D011159:Population Surveillance / Q000379:methods; D015995:Prevalence; D018357:Respiratory Syncytial Virus Infections / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D018113:Respiratory Syncytial Virus, Human / Q000235:genetics / Q000302:isolation & purification*; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D013019:South Africa / Q000453:epidemiology