title: Polyomaviruses-associated respiratory infections in HIV-infected and HIV-uninfected children.
abstract: BACKGROUND
  Two recently discovered polyomaviruses (PyV), WU and KI, have been identified in respiratory-tract specimens from children with acute respiratory infections, although there are limited data in HIV-infected children.
  
  
  OBJECTIVE
  To determine the prevalence and clinical manifestations of WUPyV and KIPyV-associated lower respiratory tract infections (LRTIs) hospitalization in HIV-infected and -uninfected children; and probe the role of pneumococcal co-infection.
  
  
  METHODS
  Nasopharyngeal aspirates were collected from a cohort of 39,836 children randomized to receive 9-valent pneumococcal conjugate vaccine (PCV9) or placebo when hospitalized for LRTIs, and were screened by PCR for WUPyV, KIPyV and other respiratory viruses.
  
  
  RESULTS
  In placebo-recipients the prevalence of WUPyV was 6.3% (18/285) in HIV-infected and 13.9% (66/476) in HIV-uninfected children (p=0.002). In WUPyV-positive LRTIs HIV-infected children had lower oxygen saturation at admission and a higher case fatality rate (11.1% vs. 0%; p=0.04). KIPyV was identified in 10.2% (29/285) of HIV-infected and in 7.4% (35/476) of HIV-uninfected placebo-recipients with LRTIs (p=0.13). HIV-infected compared to HIV-uninfected children with KIPyV-positive LRTIs had lower oxygen saturation, higher respiratory rate and longer duration of hospitalization. Co-infections with other respiratory-viruses were detected in 65.5% of WUPyV-positive LRTIs and in 75.0% of KIPyV-positive LRTIs. Among HIV-uninfected children, there was a lower incidence of hospitalization for clinical pneumonia episodes in which KIPyV (80%; 95% CI: 41, 93) and WUPyV (49%; 95% CI: 9, 71) were identified among PCV9-recipients compared to placebo-recipients.
  
  
  CONCLUSIONS
  Polyomaviruses were commonly identified in HIV-infected and -uninfected children hospitalized for LRTIs, frequently in association with other viruses and may contribute to the pathogenesis of pneumococcal pneumonia.
authors.affiliation: Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Marta C
authors.initials: MC
authors.lastname: Nunes
authors.affiliation: Stony Brook School of Medicine, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Kuschner
authors.affiliation: Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Zelda
authors.initials: Z
authors.lastname: Rabede
authors.affiliation: Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Clare L
authors.initials: CL
authors.lastname: Cutland
authors.affiliation: Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Richard
authors.initials: R
authors.lastname: Madimabe
authors.affiliation: Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Locadiah
authors.initials: L
authors.lastname: Kuwanda
authors.affiliation: Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Hubert Department of Global Health, Rollins School of Public Health and Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
authors.affiliation: Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Adrian
authors.affiliation: Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Institute for Communicable Diseases: a division of National Health Laboratory Service, Centre for Vaccines and Immunology, Johannesburg, South Africa. Electronic address: shabirm@nicd.ac.za.
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
mesh_terms: D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D009305:Nasopharynx / Q000382:microbiology / Q000821:virology; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology / Q000473:pathology; D011120:Polyomavirus / Q000302:isolation & purification*; D027601:Polyomavirus Infections / Q000453:epidemiology* / Q000473:pathology; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000473:pathology
keywords: HIV; PCV9; Pneumococcal vaccine; Pneumonia; Polyomaviruses; Respiratory infections