Human immunodeficiency virus infections and the respiratory system in children

Bye, Michael R.

doi:10.1002/ppul.1950190408

Cited by 8 publications

(3 citation statements)

References 144 publications

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“…Pneumonia is a major complication in human immunode ciency virus (HIV)-infected children; however, there are few published reports of the aetiology and outcome of this problem in developing countries (1)(2)(3). Studies of adult HIV-infected patients in Africa suggest that the spectrum of pulmonary disease differs from that of developed nations; tuberculosis (TB), pyogenic pneumonia and non-speci c interstitial pneumonia predominate, and Pneumocystis carinii pneumonia (PCP) is less common (4)(5)(6)(7).…”

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confidence: 99%

Aetiology and outcome of pneumonia in human immunodeficiency virus‐infected children hospitalized in South Africa

et al. 2001

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To determine the aetiology and outcome of pneumonia in human immunodeficiency virus (HIV)‐infected children, we prospectively investigated 250 children hospitalized with pneumonia who were known or clinically suspected to be HIV‐positive, or who required intensive care support in Cape Town, South Africa. Blood culture, induced sputum or bronchoalveolar lavage nasopharyngeal aspirate and gastric lavage were performed. Of the total, 151 children (60.4%) were HIV‐infected. Pneumocystis carinii pneumonia (PCP), occurring in 19 (7.6%) children (15 HIV‐positive), was the AIDS‐defining infection in 20.3%. The incidence and type of bacteraemia (14.3%) were similar in HIV‐positive and HIV‐negative patients; S. pneumoniae (5%) and S. aureus (2%) were the predominant isolates. Sputum or BAL cultures yielded bacteria in 145 of 243 (60%) specimens; viruses were cultured in 37 (15.2%). Bacterial prevalence (including M. tuberculosis in 8%) and anti‐microbial resistance did not differ by HIV status except for S. aureus which was more common in HIV‐infected children. Thirty‐one (20%) HIV‐positive and 8 (8%) HIV‐negative children died [RR 1.16 (95% CI 1.05–1.28), p= 0.008]; using multiple logistic regression, PCP was the only risk factor for mortality (p= 0.03). Conclusion: In South Africa, PCP is an important AIDS‐defining infection in children; bacterial pathogens occur commonly and with a similar prevalence in HIV‐positive and HIV‐negative children hospitalized for pneumonia. HIV‐infected children with pneumonia have a worse outcome than HIV‐negative patients.

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Aetiology and outcome of pneumonia in human immunodeficiency virus‐infected children hospitalized in South Africa

et al. 2001

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“…Children with AIDS commonly have infectious and noninfectious pulmonary complications, which ultimately end in death. 1 Among the most frequent complications are acute pneumonia secondary to bacterial, fungal or Pneumocystis carinii infections, and lymphocytic interstitial pneumonitis. 1 Flexible ®beroptic bronchoscopy with bronchoalveolar lavage (BAL) is a safe and effective method for diagnosing pulmonary infections in immunocompromised children.…”

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confidence: 99%

“…1 Among the most frequent complications are acute pneumonia secondary to bacterial, fungal or Pneumocystis carinii infections, and lymphocytic interstitial pneumonitis. 1 Flexible ®beroptic bronchoscopy with bronchoalveolar lavage (BAL) is a safe and effective method for diagnosing pulmonary infections in immunocompromised children. 2,3 Whereas BAL cellular results (lymphocytic or neutrophilic alveolitis) have a relatively low diagnostic yield in adults with AIDS-related pulmonary disease and in children, 4±9 BAL differential cell counts can reliably predict the outcome of patients with human immunode-®ciency virus type 1 (HIV-1) infections and pulmonary involvement.…”

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confidence: 99%

Cellular and noncellular components of bronchoalveolar lavage fluid in HIV‐1‐infected children with radiological evidence of interstitial lung damage*

Midulla

Strappini

Sandström

et al. 2001

Pediatric Pulmonology

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Children with acquired immune deficiency syndrome (AIDS) commonly have recurrent infectious and noninfectious lung complications that ultimately end in death. To study the intensity of alveolar inflammation and to evaluate the clinical utility of bronchoalveolar lavage (BAL) in children with HIV-1 infections, we retrospectively analyzed differential cell counts, lymphocyte subsets, and fibronectin and hyaluronic acid concentrations in BAL fluid of 18 HIV-1-positive children (9 boys, mean age 3.5 years, range 5 months-8 years) with radiological evidence of interstitial lung disease, and 19 control children who had undergone BAL for clinical indications not involving the lung parenchyma (13 boys, mean age 3 years, range 2 months-14 years). BAL fluid from 89% of the HIV-1 infected children showed CD8+ve lymphocytic alveolitis expressing HLA-DR, CD54, and CD 69 antigens. BAL fluid from HIV-infected patients typically contained markedly increased percentages and numbers of lymphocytes (P < 0.0001) and eosinophils (P < 0.04) and significantly higher concentrations of albumin (P < 0.05) and fibronectin (P < 0.0006) than fluids from control children. Whereas BAL cellular components did not differ in P. carinii-positive and P. carinii-negative HIV-1-infected children, fibronectin concentrations were significantly higher in P. carinii-positive than negative children. BAL cell differentials and noncellular components were related neither to severity of disease nor to patients' disease progression. These findings indicate that BAL is useful in studying the intensity of lung inflammation in children with HIV-1 infections and radiologically documented interstitial lung disease, but provides no information on the subsequent clinical course.

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