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Pneumocystis Pneumonia in South African Children With and Without Human Immunodeficiency Virus Infection in the Era of Highly Active Antiretroviral Therapy

Morrow, Brenda M. PhD*; Hsaio, Nei-Yuan FCPath Viro (SA)†; Zampoli, Marco FCPaed SA*‡; Whitelaw, Andrew FCPath Micro (SA)§; Zar, Heather J. PhD*‡

Pediatric Infectious Disease Journal: June 2010 - Volume 29 - Issue 6 - pp 535-539
doi: 10.1097/INF.0b013e3181ce871e
Original Studies

Background: Pneumocystis pneumonia (PCP) is a major cause of hospitalization and mortality in human immunodeficiency virus (HIV)-infected African children.

Aim: The aim of this study was to investigate the incidence and outcome of PCP in South African children living in a high HIV-prevalence area in the context of a free, available antiretroviral therapy program.

Methods: Sequential children hospitalized with hypoxic pneumonia were prospectively enrolled from November 2006 to August 2008. Sociodemographic, historical, clinical, and outcome data were collected. A nasopharyngeal aspirate and lower respiratory tract sample (induced sputum or bronchoalveolar lavage) were submitted for PCP immunofluorescence. Lower respiratory tract samples were also investigated for bacterial, mycobacterial, and viral pathogens.

Results: A total of 202 children were enrolled; 124 (61.4%) were HIV-infected; 34 (16.8%) were HIV-exposed but uninfected and 44 (21.8%) were HIV-unexposed. Among HIV-exposed children, 70 (44.3%) had participated in the Prevention of Mother to Child Transmission program, but only 18.4% were taking trimethoprim-sulfamethoxazole prophylaxis. PCP occurred in 43 children (21.3%) of whom 33 (76.7%) were HIV-infected. The case fatality of children with PCP was higher than those without PCP (39.5% vs. 21.4%; relative risk, 1.85; 95% confidence interval, 1.15–2.97; P = 0.01).

Conclusions: PCP is a common cause of hypoxic pneumonia and mortality in HIV-infected South African infants. Underuse of the Prevention of Mother to Child Transmission program and failure to institute trimethoprim-sulfamethoxazole prophylaxis in HIV-exposed children identified through the program are important obstacles to reducing PCP incidence.

From the *Department of Paediatics and Child Health, University of Cape Town, Cape Town, South Africa; †Division of Clinical Virology, National Health Laboratory Services, University of Cape Town, Cape Town, South Africa; ‡Department of Pediatric Pulmonology, Red Cross Children's Hospital, Cape Town, South Africa; and §Division of Medical Microbiology, National Health Laboratory Services, University of Cape Town, Cape Town, South Africa.

Accepted for publication December 8, 2009.

Supported by National Research Foundation, South Africa; ASTRA-Zeneca Respiratory Award from the South African Thoracic Society; and Medical Research Council of Southern Africa.

The authors have no conflicts of interests to declare.

Address for correspondence: Brenda M. Morrow, PhD, UCT School of Child and Adolescent Health, 5th Floor, Institute of Child Health Building, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch 7700, Cape Town, South Africa. E-mail: brenda.morrow@uct.ac.za.

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© 2010 Lippincott Williams & Wilkins, Inc.