Children with HIV Might Benefit from Immunization

Between 500,000 and 870,000 children die each year from rotavirus diarrhea in developing countries, where diarrheal disease is a leading cause of illness and death among children with HIV. This study, conducted by Nigel Cunliffe and colleagues from Liverpool University, U.K., and the Wellcome Trust Research Laboratories, College of Medicine, Blantyre, Malawi, examined the effects of HIV infection on the clinical course and outcome of rotavirus gastroenteritis in Malawian children. Their findings were published in a recent issue of Lancet (August 18, 2001; Vol. 358; P. 550-55).

Children younger than age five who were treated for acute gastroenteritis at the Queen Elizabeth Central Hospital in Blantyre were enrolled. Those with rotavirus diarrhea, with or without HIV infection, were followed for up to four weeks after hospital discharge. A total of 786 inpatients (average age 8 months, 34 percent of whom had HIV-1), and 400 outpatients (average age 9 months, 16 percent of whom had HIV-1) were enrolled.

Rotavirus was detected less frequently among the HIV-1 infected than among those uninfected (30 percent compared with 41 percent). There were no differences in rotavirus disease severity between the two groups, but HIV-infected children were more likely to die during follow-up (22 percent compared with 0 percent). Shedding of rotavirus at follow-up was more common among HIV-infected children (21 percent compared with 4 percent) although this was not associated with increased incidence of diarrhea.

Results of the hospital-based study suggest that children with HIV infection could potentially benefit from vaccination against rotavirus, the main cause of severe, dehydrating diarrhea in infants and children worldwide. "Our study should now encourage careful studies of the safety of rotavirus vaccines in HIV-infected infants. The possible effect of rotavirus vaccine on host HIV disease needs assessment, and the possibility of prolonged excretion of vaccine virus should be considered. Such studies would represent a significant advance towards the goal of reducing childhood mortality from rotavirus across Africa, through the routine rotavirus vaccination of infants," Cunliffe and co-authors concluded.

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