BACKGROUND : Increased morbidity and mortality from lower respiratory tract infection (LRTI) abstract
has been suggested in HIV-exposed uninfected (HEU) children; however, the contribution of
respiratory viruses is unclear. We studied the epidemiology of LRTI hospitalization in HIVunexposed
uninfected (HUU) and HEU infants aged <6 months in South Africa.
METHODS : We prospectively enrolled hospitalized infants with LRTI from 4 provinces from
2010 to 2013. Using polymerase chain reaction, nasopharyngeal aspirates were tested for
10 viruses and blood for pneumococcal DNA. Incidence for 2010–2011 was estimated at 1
site with population denominators.
RESULTS : We enrolled 3537 children aged <6 months. HIV infection and exposure status were
determined for 2507 (71%), of whom 211 (8%) were HIV infected, 850 (34%) were HEU,
and 1446 (58%) were HUU. The annual incidence of LRTI was elevated in HEU (incidence
rate ratio [IRR] 1.4; 95% confidence interval [CI] 1.3–1.5) and HIV infected (IRR 3.8; 95%
CI 3.3–4.5), compared with HUU infants. Relative incidence estimates were greater in
HEU than HUU, for respiratory syncytial virus (RSV; IRR 1.4; 95% CI 1.3–1.6) and human
metapneumovirus–associated (IRR 1.4; 95% CI 1.1–2.0) LRTI, with a similar trend observed
for influenza (IRR 1.2; 95% CI 0.8–1.8). HEU infants overall, and those with RSV-associated
LRTI had greater odds (odds ratio 2.1, 95% CI 1.1–3.8, and 12.2, 95% CI 1.7–infinity,
respectively) of death than HUU.
CONCLUSIONS : HEU infants were more likely to be hospitalized and to die in-hospital than HUU,
including specifically due to RSV. This group should be considered a high-risk group for