Skip to main content

Advertisement

Log in

Managing HIV in the PICU — The experience at the red cross War Memorial Children’s Hospital in Cape Town

  • Symposium on Advances in Pediatric Intensive Care
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

The HIV pandemic has affected children throughout the developing world. This article describes the experience of the Paediatric Intensive Care Unit at the Red Cross War Memorial Children’s Hospital in Cape Town, South Africa. Over the last 20 years we have improved our management of HIV infected children requiring intensive care admission. In the absence of anti-retroviral therapy, long term outcomes from PICU admission of HIV infected children have not improved significantly, and it is debatable whether PICU admission is justfied. Once anti-retroviral therapy is available to children, there may be significant improvements in outcome and possible affected children should be admitted to the PICU if resources are available.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Centers for Disease Control. Pneumocystis pneumonia—Los Angeles. MMWR Morb Mortal Wkly Rep 981; 30: 250–252.

  2. http://www.unicef.org/infobycountry/southafrica_statistics.html

  3. Zwi K, Pettifor J, Soderlund N, Meyers T. HIV infection and in-hospital mortality at an academic hospital in South Africa. Arch Dis Child 2000; 83: 227–230.

    Article  PubMed  CAS  Google Scholar 

  4. Zwi KJ, Pettifor JM, Soderlund N. Paediatric hospital admissions at a South African urban regional hospital: the impact of HIV, 1992–1997. Ann Trop Paediatr 1999; 19: 135–142.

    Article  PubMed  CAS  Google Scholar 

  5. Madhi SA, Ramasamy N, Bessellar TG, Saloojee H, Klugman KP. Lower respiratory tract infections associated with influenza A and B viruses in an area with a high prevalence of pediatric human immunodeficiency type 1 infection. Pediatr Infect Dis J 2002; 21: 291–297.

    Article  PubMed  Google Scholar 

  6. Rabie H, Boer AD, Bos SV, Cotton MF, Kling S, Goussard P. Children with Human Immunodeficiency Virus Infection Admitted to a Paediatric Intensive Care Unit in South Africa. J Trop Pediatr 2007; 53: 270–273. Epub 2007 May 25.

    Article  PubMed  Google Scholar 

  7. Graham SM. Non-tuberculosis opportunistic infections and other lung diseases in HIV-infected infants and children. Int J Tuberc Lung Dis 2005; 9: 592–602.

    PubMed  CAS  Google Scholar 

  8. Chintu C, Mudenda V, Lucas S, Nunn A, Lishimpi K, Maswahu D et al. Lung diseases at necropsy in African children dying from respiratory illnesses: a descriptive necropsy study. Lancet 2002: 28: 360: 985–990.

    Article  PubMed  Google Scholar 

  9. King JC, Jr, Burke AR, Clemens JD, Nair P, Farley JJ, Vink PE, et al. Respiratory syncytial virus illnesses in human immunodeficiency virus-and noninfected children. Pediatr Infect Dis J 1993; 12: 733–739.

    Article  PubMed  Google Scholar 

  10. Klugman KP, Madhi SA, Huebner RE, Kohberger R, Mbelle N, Pierce N et al. A trial of a 9-valent pneumococcal conjugate vaccine in children with and those without HIV infection. N Engl J Med 2003 2; 349: 1341–1348.

    Article  PubMed  CAS  Google Scholar 

  11. Jeena PM, Pillay P, Pillay T, Coovadia HM. Impact of HIV-1 co-infection on presentation and hospital-related mortality in children with culture proven pulmonary tuberculosis in Durban, South Africa. Int J Tuberc Lung Dis 2002; 6: 672–678.

    PubMed  CAS  Google Scholar 

  12. Madhi SA, Huebner RE, Doedens L, Aduc T, Wesley D, Cooper PA. HIV-1 co-infection in children hospitalised with tuberculosis in South Africa. Int J Tuberc Lung Dis 2000; 4: 448–454.

    PubMed  CAS  Google Scholar 

  13. Fatti GL, Zar HJ, Swingler GH. Clinical indicators of Pneumocystis jiroveci pneumonia (PCP) in South African children infected with the human immunodeficiency virus. Int J Infect Dis 2006; 10: 282–285.

    Article  PubMed  Google Scholar 

  14. Bakeera-Kitaka S, Musoke P, Downing R, Tumwine JK. Pneumocystis carinii in children with severe pneumonia at Mulago Hospital, Uganda. Ann Trop Paediatr 2004; 24: 227–235.

    Article  PubMed  Google Scholar 

  15. Zar HJ. Pneumocystis carinii pneumonia (PCP) in HIV-infected African children. SADJ 2001; 56: 617–619.

    PubMed  CAS  Google Scholar 

  16. Richard N, Stamm D, Floret D. Pneumocystis carinii infections in a pediatric intensive care unit: a retrospective study 1980–2002. Arch Pediatr 2003; 10Suppl 5: 539s–544s.

    Article  PubMed  Google Scholar 

  17. Sheikh S, Bakshi SS, Pahwa SG. Outcome and survival in HIV-infected infants with Pneumocystis carinii pneumonia and respiratory failure. Pediatr AIDS HIV Infect 1996; 7: 155–163.

    PubMed  CAS  Google Scholar 

  18. Grimwade K, Swingler GH. Cotrimoxazole prophylaxis for opportunistic infections in children with HIV infection. Cochrane Database Syst Rev 2006; 25: CD003508.

    Google Scholar 

  19. Zar HJ, Cotton MF, Strauss S, Karpakis J, Hussey G, Schaaf HS et al. Effect of isoniazid prophylaxis on mortality and incidence of tuberculosis in children with HIV: randomised controlled trial. BMJ 2007 20; 334: 136.

    Google Scholar 

  20. Zampoli M, Kilborn T, Eley B. Tuberculosis during early antiretroviral-induced immune reconstitution in HIV-infected children. Int J Tuberc Lung Dis 2007; 11: 417–423.

    PubMed  CAS  Google Scholar 

  21. Nachman S, Gona P, Dankner W, Weinberg A, Yogev R, Gershon A et al. The rate of serious bacterial infections among HIV-infected children with immune reconstitution who have discontinued opportunistic infection prophylaxis. Pediatrics 2005; 115: e488–E494.

    Article  PubMed  Google Scholar 

  22. Cooper S, Lyall H, Walters S, Tudor-Williams G, Habibi P, de Munter C et al. Children with human immunodeficiency virus admitted to a paediatric intensive care unit in the United Kingdom over a 10-year period. Intensive Care Med 2004; 30: 113–118.

    Article  PubMed  Google Scholar 

  23. Cowburn C, Hatherill M, Eley B, Nuttall J, Hussey G, Reynolds L et al. Short-term mortality and implementation of antiretroviral treatment for critically ill HIV-infected children in a developing country. Arch Dis Child 2007; 92: 234–241.

    Article  PubMed  CAS  Google Scholar 

  24. Briel M, Bucher HC, Boscacci R, Furrer H. Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia in patients with HIV-infection. Cochrane Database Syst Rev 2006 19; 3: CD006150.

  25. Sleasman JW, Hemenway C, Klein AS, Barrett DJ. Corticosteroids improve survival of children with AIDS and Pneumocystis carinii pneumonia. Am J Dis Child 1993; 147: 30–34.

    PubMed  CAS  Google Scholar 

  26. Jeena PM, Coovadia HM, Chrystal V. Pneumocystis carinii and cytomegalovirus infections in severely ill, HIV-infected African infants. Ann Trop Paediatr 1996; 16: 361–368.

    PubMed  CAS  Google Scholar 

  27. Zar HJ, Apolles P, Argent A, Klein M, Burgess J, Hanslo D et al. The etiology and outcome of pneumonia in human immunodeficiency virus-infected children admitted to intensive care in a developing country. Pediatr Crit Care Med 2001; 2: 108–112.

    Article  PubMed  Google Scholar 

  28. Zar HJ. Pneumonia in HIV-infected and HIV-uninfected children in developing countries: epidemiology, clinical features, and management. Curr Opin Pulm Med 2004; 10: 176–182.

    Article  PubMed  Google Scholar 

  29. Jeena PM, Bobat R, Kindra G, Pillay P, Ramji S, Coovadia HM. The impact of human immunodeficency virus 1 on largyngeal airway obstruction in children. Arch Dis Child 2002; 87: 212–214.

    Article  PubMed  CAS  Google Scholar 

  30. Mulwafu WK, Argent AC, Prescott CA, Booth J. Tracheostomy in human immuno-deficiency virus infected children at the Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. Int J Pediatr Otorhinolaryngol 2007; 71: 1125–1128.

    Article  PubMed  CAS  Google Scholar 

  31. Hussey GD, Reijnhart RM, Sebens AM, Burgess J, Schaaf S, Potgieter S. Survival of children in Cape Town known to be vertically infected with HIV-1. S Afr Med J 1998; 88: 554–558.

    PubMed  CAS  Google Scholar 

  32. Spira R, Lepage P, Msellati P, Van De Perre P, Leroy V, Simonon A et al. Natural history of human immunodeficiency virus type 1 infection in children: a five-year prospective study in Rwanda. Mother-to-Child HIV-1 Transmission Study Group. Pediatrics 1999; 104: e56.

    Article  PubMed  CAS  Google Scholar 

  33. Jeena PM, Coovadia HM, Bhagwanjee S. Prospective, controlled study of the outcome of human immunodeficiency virus-1 antibody-positive children admitted to an intensive care unit. Crit Care Med 1996; 24: 963–967.

    Article  PubMed  CAS  Google Scholar 

  34. Zar HJ, Hanslo D, Tannenbaum E, Klein M, Argent A, Eley B, et al. Aetiology and outcome of pneumonia in human immunodeficiency virus-infected children hospitalized in South Africa. Acta Paediatr 2001; 90: 119–125.

    Article  PubMed  CAS  Google Scholar 

  35. Coovadia H, McNally L, Jeena P. The etiology and outcome of pneumonia in human immunodeficiency virus-infected children admitted to intensive care in a developing country: A commentary. Pediatr Crit Care Med 2001; 2: 280–281.

    Article  PubMed  Google Scholar 

  36. Thirsk ER, Kapongo MC, Jeena PM, Liebeschuetz S, York DF, Vega G et al. HIV-exposed infants with acute respiratory failure secondary to acute lower respiratory infections managed with and without mechanical ventilation. S Afr Med J 2003; 93: 617–620.

    PubMed  CAS  Google Scholar 

  37. Jeena PM, McNally LM, Stobie M, Coovadia HM, Adhikari MA, Petros AJ. Challenges in the provision of ICU services to HIV infected children in resource poor settings: a South African case study. J Med Ethics 2005; 31: 226–230.

    Article  PubMed  CAS  Google Scholar 

  38. de Martino M, Tovo PA, Balducci M, Galli L, Gabiano C, Rezza G et al. Reduction in mortality with availability of antiretroviral therapy for children with perinatal HIV-1 infection. Italian Register for HIV Infection in Children and the Italian National AIDS Registry. JAMA 2000 12; 284: 190–197.

    Article  PubMed  Google Scholar 

  39. Gibb DM, Duong T, Tookey PA, Sharland M, Tudor-Williams G, Novelli V et al. Decline in mortality, AIDS, and hospital admissions in perinatally HIV-1 infected children in the United Kingdom and Ireland. BMJ 2003 1; 327: 1019.

    Article  PubMed  CAS  Google Scholar 

  40. Gona P, Van Dyke RB, Williams PL, Dankner WM, Chernoff MC, Nachman SA et al. Incidence of opportunistic and other infections in HIV-infected children in the HAART era. JAMA 2006 19; 296: 292–300.

    Article  PubMed  CAS  Google Scholar 

  41. Viani RM, Araneta MR, Deville JG, Spector SA. Decrease in hospitalization and mortality rates among children with perinatally acquired HIV type 1 infection receiving highly active antiretroviral therapy. Clin Infect Dis 2004 Sep 1; 39: 725–731.

    Article  PubMed  Google Scholar 

  42. Reddi A, Leeper SC, Grobler AC, Geddes R, France KH, Dorse GL et al. Preliminary outcomes of a paediatric highly active antiretroviral therapy cohort from KwaZulu-Natal, South Africa. BMC Pediatr 2007; 17: 7–13.

    Google Scholar 

  43. van Kooten Niekerk NK, Knies MM, Howard J, Rabie H, Zeier M, van Rensburg A et al. The first 5 years of the family clinic for HIV at Tygerberg Hospital: family demographics, survival of children and early impact of antiretroviral therapy. J Trop Pediatr 2006; 52: 3–11.

    Article  PubMed  Google Scholar 

  44. Eley B. Addressing the paediatric HIV epidemic: a perspective from the Western Cape Region of South Africa. Trans R Soc Trop Med Hyg 2006; 100: 19–23.

    Article  PubMed  Google Scholar 

  45. Puthanakit T, Aurpibul L, Oberdorfer P, Akarathum N, Kanjananit S, Wannarit P et al. Hospitalization and mortality among HIV-infected children after receiving highly active antiretroviral therapy. Clin Infect Dis 2007 15; 44: 599–604.

    Article  PubMed  CAS  Google Scholar 

  46. Shah CA. Adherence to high activity antiretrovial therapy (HAART) in pediatric patients infected with HIV: issues and interventions. Indian J Pediatr 2007; 74: 55–60.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. C. Argent.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Argent, A.C. Managing HIV in the PICU — The experience at the red cross War Memorial Children’s Hospital in Cape Town. Indian J Pediatr 75, 615–620 (2008). https://doi.org/10.1007/s12098-008-0118-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-008-0118-2

Key words

Navigation