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Respiratory syncytial virus illnesses in human immunodeficiency virus- and noninfected children
J C King1, A R Burke, J D Clemens
1Department of Pediatrics, University of Maryland School of Medicine, Baltimore 21201.
Insights
Human immunodeficiency virus (HIV)-infected infants shed respiratory syncytial virus (RSV) for significantly longer periods, posing infection control challenges. This prolonged RSV shedding in HIV-infected infants requires recognition for public health strategies.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Virology
Background:
- Respiratory Syncytial Virus (RSV) is a common cause of respiratory illness in infants.
- Infants with Human Immunodeficiency Virus (HIV) may have altered immune responses.
- Understanding RSV shedding dynamics in HIV-exposed and HIV-infected infants is crucial for management.
Purpose of the Study:
- To prospectively assess RSV lower respiratory tract and febrile upper respiratory tract illnesses in infants born to HIV-infected and non-HIV-infected mothers.
- To compare RSV shedding duration and clinical outcomes between HIV-infected and non-HIV-infected infants.
Main Methods:
- Prospective cohort study involving infants born to HIV-infected and non-HIV-infected mothers.
- Assessment of RSV illnesses, including duration of shedding, clinical symptoms, and treatment responses.
- Comparison of RSV shedding duration between HIV-infected and non-HIV-infected infants.
Main Results:
- RSV shedding was significantly prolonged in HIV-infected infants (median 30 days) compared to non-HIV-infected infants (median 6 days).
- Wheezing was less frequent in HIV-infected infants during lower respiratory tract illness episodes (1 of 4 vs. 9 of 10).
- Standard treatments failed to eradicate RSV in one infant with prolonged shedding (199 days).
Conclusions:
- HIV-infected infants experience prolonged RSV shedding, highlighting potential for increased transmission.
- Public health and infection control measures must consider the prolonged RSV shedding in HIV-infected infants.
- Further research is needed to understand the clinical implications and management of RSV in this population.
Abstract:
Respiratory syncytial virus (RSV) lower respiratory tract and febrile upper respiratory tract illnesses were prospectively assessed in cohorts of 83 infants born to human immunodeficiency virus (HIV)- and of 48 infants born to non-HIV-infected mothers. Of the infants born to HIV-infected mothers, 18 were themselves infected with HIV, 26 were indeterminant and 39 were free from HIV. Ten RSV illnesses occurred in 8 HIV-infected, 2 illnesses in 2 indeterminant and 17 illnesses occurred in 17 non-HIV-infected children. RSV shedding was prolonged in HIV class P2- vs. non-HIV-infected children, at medians of 30 days (range, 1 to 199 days) and 6 days (range, 1 to 21 days), respectively (P = 0.02). Ribavirin and intravenous immunoglobulin failed to eradicate RSV from one child who shed virus for 199 days. Wheezing occurred in 1 of 4 vs. 9 of 10 episodes of lower respiratory tract illness in HIV-infected and non-HIV-infected children, respectively (P = 0.04). No differences were noted in duration of illness, temperature, respiratory rate or oxygen saturation between HIV- and non-HIV-infected children. Infection control and public health concerns regarding prolonged shedding of RSV in HIV-infected children must be recognized.