Outcomes of HIV-1-positive children with pneumonia admitted to the paediatric intensive care unit: A retrospective review
Introduction. The outcomes of HIV-positive children with pneumonia, who require intensive care, have been poor. Advances in intensive care support for end-organ dysfunction, treatment of the primary disease and opportunistic infections could improve this outcome.
Objectives. To evaluate the incidence and outcome according to HIV status.
Methods. A retrospective chart review of the electronic dataset of children with pneumonia admitted to the paediatric intensive care unit (PICU) at Inkosi Albert Luthuli Central Hospital, Durban, South Africa was undertaken. Data on the use of ganciclovir, combination antiretroviral therapy (cART) and high frequency oscillatory ventilation (HFOV) on outcome were also evaluated.
Results. Of the 405 children with pneumonia admitted to the PICU during 2010, 77 (19%) were HIV-1-positive, and 261 (64.4%) were HIV-negative. The mortality rate among the two groups was similar (22.1% v. 15.3% (p=0.27), respectively). Among the HIV-positive cases, cytomegalovirus (CMV) was isolated in 39 (50.7%) cases, of which 18 (46.2%) required HFOV. Among the children who were treated with ganciclovir and cART, the survival rate was 90%. In HIV-positive children with CMV-associated pneumonia who received cART with ganciclovir therapy, the survival rate was 92.3%.
Conclusion. HIV-1-positive children with pneumonia requiring intensive care had a similar outcome to HIV-negative children with pneumonia. HIV-1-positive children with CMV-associated pneumonia on ganciclovir, cART, and HFOV have improved outcomes in comparison to previous studies.
P M Jeena, Department of Paediatric and Child Health, University of KwaZulu-Natal, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
L Githinji, Department of Paediatric and Child Health, University of KwaZulu-Natal, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
Robin Green, University of Pretoria
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Date published: 2017-08-11
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African Journal of Thoracic and Critical Care Medicine| Online ISSN: 2617-0205
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