BACKGROUND: Children with HIV infection are particularly susceptible to pneumococcal disease. Nasopharyngeal (NP) colonization with S. pneumoniae is necessary for development of invasive disease, but carriage rates in children infected with HIV have not been determined. Resistance to penicillin and other antibiotics in S. pneumoniae has been increasing, but rates have not been determined in children with HIV infection.

OBJECTIVE: To determine the prevalence of NP colonization and antibiotic resistance of S. pneumoniae in children attending an HIV clinic.

METHODS: Patients were matched by age with controls (asthma or bronchopulmonary dysplasia). NP cultures were obtained from 220 children. The HIV clinic group included 62 HIV infected, 23 indeterminate, and 25 uninfected children.

RESULTS:Colonization rate with S. pneumoniae in the HIVclinic was equal to the control population (21% vs. 18%, p=.64). Carriage in HIV infected children (19%) was no different than uninfected subjects. Colonization was as likely in children receiving cotrimoxazole (T/S) (p=.55), penicillins (p=.47), or cephalosporins (p=.49). Age was the strongest factor associated with S. pneumoniae colonization, with increased risk between 6 and 24 months of age. (OR =5.2; CI:1.1, 24).

HIVclinic and controls did not differ in pneumococcal resistance to T/S(p=.30), despite 55% T/S use in the HIV clinic. Penicillin resistance was more likely in the pulmonary (50%) than HIVclinic (16%, OR=4.75; CI: 1.18, 19.1). T/S use did not correlate with resistance to T/S (p=.27)or penicillin(p=.66).

CONCLUSION: Children attending an HIV clinic, and those infected with HIV, had similar NP carriage rates of S. pneumoniae as did other chronically ill children. T/S did not decrease NP carriage nor affect resistance to penicillin or T/S. Penicillin resistance in the HIV population was substantially lower than in another chronically ill population.