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Published on: December 10, 2013
Polyomaviruses-associated respiratory infections in HIV-infected and HIV-uninfected children
Marta C Nunes1, Zachary Kuschner2, Zelda Rabede3
1Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Insights
Newly discovered polyomaviruses (PyV), WU and KI, are common in children hospitalized with lower respiratory tract infections (LRTIs). These viruses, particularly WU PyV, pose a higher fatality risk in HIV-infected children and may contribute to pneumococcal pneumonia.
Area of Science:
- Virology
- Pediatrics
- Infectious Diseases
Background:
- Two novel polyomaviruses (PyV), WU and KI, have been detected in respiratory samples from children with acute respiratory infections.
- Limited data exist regarding the prevalence and impact of these polyomaviruses in HIV-infected children.
- Understanding the role of these viruses in pediatric lower respiratory tract infections (LRTIs) is crucial.
Purpose of the Study:
- To investigate the prevalence and clinical features of WU polyomavirus (WUPyV) and KI polyomavirus (KIPyV)-associated LRTIs in hospitalized HIV-infected and HIV-uninfected children.
- To examine the potential role of pneumococcal co-infection in WUPyV and KIPyV-positive LRTIs.
- To assess the impact of pneumococcal conjugate vaccine (PCV9) on WUPyV and KIPyV-associated pneumonia hospitalizations.
Main Methods:
- Nasopharyngeal aspirates were collected from 39,836 children hospitalized with LRTIs, randomized to receive 9-valent pneumococcal conjugate vaccine (PCV9) or placebo.
- Polymerase chain reaction (PCR) was used to screen for WUPyV, KIPyV, and other respiratory viruses.
- Clinical data, including oxygen saturation, respiratory rate, and case fatality, were analyzed in relation to viral detection and HIV status.
Main Results:
- WUPyV prevalence was 6.3% in HIV-infected and 13.9% in HIV-uninfected children (p=0.002). HIV-infected children with WUPyV LRTIs had lower oxygen saturation and higher fatality rates (11.1% vs. 0%; p=0.04).
- KIPyV prevalence was 10.2% in HIV-infected and 7.4% in HIV-uninfected children (p=0.13). KIPyV LRTIs were associated with lower oxygen saturation, higher respiratory rate, and longer hospitalization in HIV-infected children.
- Co-infections with other respiratory viruses were common (65.5% for WUPyV, 75.0% for KIPyV). Among HIV-uninfected children, PCV9 recipients showed a reduced incidence of pneumonia hospitalization with KIPyV and WUPyV detection compared to placebo recipients.
Conclusions:
- Polyomaviruses (WUPyV and KIPyV) are frequently detected in children hospitalized for LRTIs, irrespective of HIV status.
- These viruses are often found in conjunction with other respiratory pathogens and may play a role in the pathogenesis of pneumococcal pneumonia.
- The findings highlight the importance of considering polyomaviruses in pediatric respiratory infections, especially in immunocompromised populations.
Background:
Two recently discovered polyomaviruses (PyV), WU and KI, have been identified in respiratory-tract specimens from children with acute respiratory infections, although there are limited data in HIV-infected children.
Objectives:
To determine the prevalence and clinical manifestations of WUPyV and KIPyV-associated lower respiratory tract infections (LRTIs) hospitalization in HIV-infected and -uninfected children; and probe the role of pneumococcal co-infection.
Study Design:
Nasopharyngeal aspirates were collected from a cohort of 39,836 children randomized to receive 9-valent pneumococcal conjugate vaccine (PCV9) or placebo when hospitalized for LRTIs, and were screened by PCR for WUPyV, KIPyV and other respiratory viruses.
Results:
In placebo-recipients the prevalence of WUPyV was 6.3% (18/285) in HIV-infected and 13.9% (66/476) in HIV-uninfected children (p=0.002). In WUPyV-positive LRTIs HIV-infected children had lower oxygen saturation at admission and a higher case fatality rate (11.1% vs. 0%; p=0.04). KIPyV was identified in 10.2% (29/285) of HIV-infected and in 7.4% (35/476) of HIV-uninfected placebo-recipients with LRTIs (p=0.13). HIV-infected compared to HIV-uninfected children with KIPyV-positive LRTIs had lower oxygen saturation, higher respiratory rate and longer duration of hospitalization. Co-infections with other respiratory-viruses were detected in 65.5% of WUPyV-positive LRTIs and in 75.0% of KIPyV-positive LRTIs. Among HIV-uninfected children, there was a lower incidence of hospitalization for clinical pneumonia episodes in which KIPyV (80%; 95% CI: 41, 93) and WUPyV (49%; 95% CI: 9, 71) were identified among PCV9-recipients compared to placebo-recipients.
Conclusions:
Polyomaviruses were commonly identified in HIV-infected and -uninfected children hospitalized for LRTIs, frequently in association with other viruses and may contribute to the pathogenesis of pneumococcal pneumonia.
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