Results of a hospital-based study in Malawi published in this week’s issue of THE LANCET suggest that children with HIV infection could potentially benefit from vaccination against rotaviruses, the main cause of severe, dehydrating diarrhoea in infants and young children throughout the world.
An estimated 500,000-870,000 children die every year from rotavirus diarrhoea in less-developed countries. Diarrhoeal 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, UK, 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. Those with rotavirus diarrhoea, with and without HIV infection, were followed up for up to 4 weeks after hospital discharge. 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 hospitalised children with and without HIV infection, but 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 diarrhoea.
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.”
Contact: Dr Nigel A Cunliffe, Department of Medical Microbiology and Genito-Urinary Medicine, University of Liverpool, Duncan Building, Daulby Street, Liverpool L69 3GA, UK; T) 44-151-706-4381; F) 44-151-706-5805; E) N.A.Cunliffe@liverpool.ac.uk
Journal
The Lancet