ABSTRACT
BACKGROUND: Human immunodeficiency virus (HIV) infected children have an eleven-fold risk of acute lower respiratory tract infection. This places HIV-infected children at risk of airway destruction and bronchiectasis. OBJECTIVE: To study predisposing factors for the development of bronchiectasis in a developing world setting. METHODS: Children with HIV-related bronchiectasis aged 6-14 years were enrolled. Data were collected on demographics, induced sputum for tuberculosis, respiratory viruses (respiratory syncytial virus), influenza A and B, parainfluenza 1-3, adenovirus and cytomegalovirus), bacteriology and cytokines. Spirometry was performed. Blood samples were obtained for HIV staging, immunoglobulins, immunoCAP®-specific immunoglobulin E (IgE) for common foods and aeroallergens and cytokines. RESULTS: In all, 35 patients were enrolled in the study. Of 161 sputum samples, the predominant organisms cultured were Haemophilus influenzae and parainfluenzae (49%). The median forced expiratory volume in 1 second of all patients was 53%. Interleukin-8 was the predominant cytokine in sputum and serum. The median IgE level was 770 kU/l; however, this did not seem to be related to atopy; 36% were exposed to environmental tobacco smoke, with no correlation between exposure and CD4 count. CONCLUSION: Children with HIV-related bronchiectasis are diagnosed after the age of 6 years and suffer significant morbidity. Immune stimulation mechanisms in these children are intact despite the level of immunosuppression.
Subject(s)
AIDS-Related Opportunistic Infections/epidemiology , Bronchiectasis/epidemiology , Coinfection/epidemiology , HIV Infections/epidemiology , Tuberculosis, Pulmonary/epidemiology , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/immunology , Adolescent , Antiretroviral Therapy, Highly Active , Bacteriological Techniques , Bronchiectasis/diagnosis , Bronchiectasis/immunology , Child , Coinfection/diagnosis , Coinfection/immunology , Cytokines/isolation & purification , Developing Countries , HIV Infections/diagnosis , HIV Infections/drug therapy , HIV Infections/immunology , Humans , Immunologic Tests , Inflammation Mediators/isolation & purification , Mycobacterium tuberculosis/isolation & purification , Risk Assessment , Risk Factors , South Africa/epidemiology , Spirometry , Sputum/immunology , Sputum/microbiology , Sputum/virology , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/immunologyABSTRACT
BACKGROUND: Pneumonia in South African children remains a major public health concern. The costs of hospital admission for pneumonia should be determined, especially where human immunodeficiency virus (HIV) infection is common. OBJECTIVE: To determine the hospital costs of children (HIV-infected vs. non-HIV-infected) admitted for the management of pneumonia and compare them in the public and fee-for-service sectors. METHODS: A retrospective review of paediatric admissions in 2007 was performed. Costs were determined for the public and fee-for-service sectors. Outcome measures included hospital mortality and comparative costs of admission. RESULTS: There were 132 admissions in a public sector facility (67% HIV-infected), and 7882 in the fee-for-service sector (1.2% HIV-infected). Total mortality was respectively 25% in the public and 0.04% in the fee-for-service sectors. The mean cost for HIV-infected patients was respectively US$639.06 and US$10 540.04 in the public and fee-for-service sectors. For non-HIV-infected patients, the cost was respectively US$399.45 and US$3936.87. Length of stay for HIV-infected patients was longer by respectively 1.8 days and 5.7 days in the public sector among admissions to the ward and to the paediatric intensive care unit. CONCLUSION: Admission for HIV-infected children with pneumonia costs significantly more in both sectors. Preventive strategies are needed.
