Research

The impact of highly active antiretroviral therapy on the burden of bacterial lower respiratory tract infections in children.

K R de Campos, D D Granga, S Olorunju, R Masekela

Abstract


Background. Respiratory diseases are common and associated with significant morbidity and mortality in children.

Objective. To evaluate the prevalence and outcome of bacterial lower respiratory tract infections (LRTIs) in HIV-infected and uninfected children at a primary level hospital.

Methods. A cross-sectional descriptive study of children aged 6 months - 18 years was conducted. Recruitment included HIV-positive children who had been on highly active antiretroviral therapy (HAART) for at least 6 months. A comparator group of HIV-negative children admitted with bacterial pneumonia was included. Laboratory data collected included CD4+ T-cell counts, HIV viral load and C-reactive protein (CRP). Data collected in both groups included demographic data, immunisation status, zinc supplementation, previous LRTIs, environmental exposures and treatment.

Results. Fifty-nine HIV-infected and 20 uninfected children were enrolled. The HIV-positive children were older, with a mean age of 107.2 (standard deviation 50.0) months v. 12.0 (5.8) months (p<0.005). The HIV-infected group had a mean CD4 percentage of 31.5%, and had had an average of 3.9 visits for bacterial LRTIs. All were treated with amoxicillin with no complications. In the HIV-uninfected group, cough and rapid breathing were the most common presenting symptoms, and the mean CRP level was 463.0 mg/L. The mean hospital stay was 4 days.

Conclusion. HAART is effective in reducing the burden of LRTIs in HIV-positive children, even when the diagnosis is delayed. Cough and fast breathing are still the most reliable presenting symptoms of pneumonia. The majority of children still respond to amoxicillin as first-line therapy, with low complication rates. 

 


Authors' affiliations

K R de Campos, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa, and Steve Biko Academic Hospital, Pretoria, South Africa

D D Granga, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa, and Steve Biko Academic Hospital, Pretoria, South Africa

S Olorunju, Biostatistics Unit, Medical Research Council, Pretoria, South Africa

R Masekela, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa, and Steve Biko Academic Hospital, Pretoria, South Africa; Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

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Keywords

Antiretroviral therapy; Pneumonia; Paediatrics; Complications; Prevention

Cite this article

South African Medical Journal 2015;105(7):554-557. DOI:10.7196/SAMJnew.7820

Article History

Date submitted: 2015-03-16
Date published: 2015-09-21

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