Rotaviruses are the main cause of severe dehydrating diarrhea in infants and young children throughout the world.
An estimated 500,000-870,000 children die every year from rotavirus diarrhea in less-developed countries.
Diarrheal disease is a leading cause of illness and death in HIV-infected children in these areas. However, use of rotavirus vaccines in children with HIV infection is not recommended, pending further research into the outcomes of children infected with both diseases.
Nigel Cunliffe and colleagues from Liverpool University, England, and the Wellcome Trust Research Laboratories, College of Medicine, Blantyre, Malawi, examined the effect of HIV infection on the clinical presentation and outcome of rotavirus gastroenteritis in Malawian children.
Children younger than 5 years, who were treated for acute gastroenteritis at the Queen Elizabeth Central Hospital in Blantyre, were enrolled.
|500,000-870,000 children die every year from rotavirus infection.|
Those with rotavirus diarrhea, with and without HIV infection, were followed up for up to 4 weeks after hospital discharge.
A total of 786 inpatients (average age 8 months, 34% of whom were HIV-1-infected), and 400 outpatients (average age 9 months, 16% of whom were HIV-1-infected), were enrolled.
Rotavirus was detected less frequently among HIV-1-infected children than among HIV-1-uninfected children (30% compared with 41%).
There was no difference in rotavirus disease severity for hospitalized children with and without HIV infection. However, HIV-infected children were more likely to die during follow-up (22% compared with 0%).
Shedding of rotavirus at follow-up was more common among HIV-infected children (21% compared with 4%), although this was not associated with increased incidence of diarrhea.
Nigel Cunliffe comments, "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."