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Journal of Tropical Pediatrics Advance Access published online on November 25, 2007
Journal of Tropical Pediatrics, doi:10.1093/tropej/fmm088
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© The Author [2007]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Children with Human Immunodeficiency Virus Infection Admitted to a Paediatric Intensive Care Unit in South Africa

Helena Rabiea, Anna de Boerb *, Suzanne van den Bosb *, Mark F. Cottona, Sharon Klinga and Pierre Goussarda

aDepartment of Paediatrics and Child Health, Tygerberg Children's Hospital & Stellenbosch University, Parow 7505, South Africa bUniversity of Amsterdam, Amsterdam

Correspondence: Helena Rabie, C3A Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Parow 7505, South Africa. E-mail < hrabie{at}sun.ac.za>.


  Abstract

Background: Early data regarding the outcome of human immunodeficiency virus (HIV)-infected children in paediatric intensive care units (PICUs) suggested mortality as high as 100%. Recent studies report mortality of 38%. Survival depends on the indication for admission. Objectives: The objective of the study is to describe the prevalence, duration of stay and outcome of HIV-infected patients in a single PICU over a 1-year period. Additional objectives included describing the indications for admission as well as the clinical and laboratory characteristics of HIV-infected infants and children requiring PICU admission.

Methods: Retrospective chart review of all children with serological proof of HIV admitted to PICU at Tygerberg Children's Hospital from 1 January–31 December 2003 was studied.

Results: Of 465 patients admitted, 47 (10%) were HIV infected. For HIV-infected children, the median age on admission was 4 months. The median duration of stay was 6 days, significantly longer than for the non-HIV group (p = 0.0001). Fifty-seven percent had advanced clinical and immunological disease. Seventeen died in PICU and 4 shortly afterwards; poor PICU outcome was significantly associated with HIV status (p = 0.001). Lower total lymphocyte count (p = 0.004) and higher gamma globulin level (p = 0.04) were paradoxically, the only findings significantly associated with survival. Acute respiratory failure (ARF) accounted for 76% of admissions, including Pneumocystis jiroveci in 38%. Fifty-one percent had evidence of cytomegalovirus infection. Conclusions: HIV-infected children requiring PICU can survive despite the lack of availability of antiretroviral therapy.

Key Words: HIV • paediatric intensive care unit • outcome • Pneumocystis jiroveci pneumonia

*These authors contributed equally to this study.


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