Journal of Antivirals & Antiretrovirals
Open Access
ISSN: 1948-5964
ISSN: 1948-5964
Robin J Green
Scientific Tracks Abstracts: JAA
Although bacterial pneumonia is an important disease entity in HIV-infected children, of equal importance is the contribution viruses make to lung disease in these children. Acute bronchiolitis is defi ned as viral-induced infl ammation of bronchioles. Bronchiolitis is a disease of infancy and presents as the fi rst episode of wheeze in HIV-infected and HIV-uninfected children alike. Th e mean age of bronchiolitis in HIV-infected children is 8 months as opposed to the HIV-uninfected children where the mean age is 5.8 months. HIV-infected bronchiolitics isolate the same viral organisms as the HIV-uninfected children, mainly RSV. RSV occurs from February to August annually, in Gauteng; although actual numbers and disease severity vary from year to year. Bacterial co-infection is a rare event and predicting bacterial infection is not aided by the measurement of C-reactive protein. Many infants who have bronchiolitis go on to wheeze repeatedly with each new viral lower respiratory tract infection. Th ey don?t have asthma. However our research work has demonstrated that in Africa the diff erential diagnosis of recurrent wheeze in infancy is much longer than in the Northern Hemisphere. We must add HIV infection and TB to this list. Admission to hospital is a frequent event for children with pneumonia. We have been auditing the costs of admission of children with pneumonia and document that the case fatality rate for HIV-associated acute pneumonia is 14% in a general ward and 46% in a PICU. Th e actual bed costs are 198 dollars for an HIV-infected child in a ward but 437 dollars in a PICU. Th at is three times higher than an HIV-uninfected child. With regard to severe pneumonia in HIV-infected children we have been experimenting with strategies to reduce mortality in Pneumocystis pneumonia (PCP). Whilst the primary cause is Pneumocystis jerovici, co-infection with viruses especially Cytomegalovirus appears to be responsible for signifi cant mortality. Th rough the use of lung protective ventilation and addition of oral steroids and ganciclovir we have reduced mortality from 90% to 22%. PCP should be regarded as a new pulmonary syndrome with multiple overlapping aetiologies, especially viral.
Dr. Robin J Green is Professor of Paediatrics and Child Health at the University of Pretoria, South Africa. He is also Director of Paediatric Respiratory and Critical Care Services at Steve Biko Academic Hospital in Pretoria. He received his Ph.D. degree in Paediatrics from the University of the Witwatersrand. He is a National Research Foundation of South Africa rated scientist and lectures and teaches widely. His current research interests include viral bronchiolitis in the developing world and asthma control measurements.