Abstract 962 Poster Session IV, Tuesday, 5/4 (poster 109)

Introduction: Respiratory infections are among the most common causes of morbidity in children with HIV infection. In this study we analyzed infections with BP in these children.

Methods: A retrospective review was undertaken of medical records from 150 HIV infected children with upper respiratory tract symptoms and cough suggestive of BP infection. Diagnosis of BP infection was made by direct florescent antibody (DFA) test using a panel of monoclonal antibody and/or culture on Regan-Lowe medium. Diagnosis of HIV infection in these children was made by ELISA and Western Blot and classified according to the 1994 CDC classification system.

Results: Diagnosis of BP infection was made in 30/150 patients (20%) between the ages of 7 months and 20 years (median 3 years). At the time of diagnosis, 21/30 children were fully immunized, 2/30 had incomplete immunizations, and 1/30 lacked immunization for BP. In the remaining 6/30, information about immunization was not available.

HIV classification status was made in 28/30 patients. Of these, 13 (46%) were in the most severe category (C) while the remaining 15 (54%) were in clinical categories N, A or B. Fifteen (54%) were severely immunocompromised (category 3) while the remaining 13(46%) were in categories 1 and 2.

All of the 150 children presented with cough and upper respiratory tract symptoms. At the time of initial diagnosis, all patients were treated with erythromycin. Only 19/30 children had follow up cultures: 11/30(37%) were negative by DFA and/or culture and became clinically asymptomatic. In 5/30 patients (17%), infection persisted for more than three months. In 5/30 patients (17%), infection recurred; two of these patients had both persistence and recurrence of BP infection. Neither persistence nor recurrence of infection correlated with clinical or immunological severity of HIV infection. Moreover, seven of these eight children were fully immunized against BP. All of the five patients with recurrent infection had progression of their clinical and immunologic class. One patient with persistent and recurrent infection has oculocutaneous albinism in addition to HIV. That patient also received BP intravenous immunoglobulin as part of therapy in addition to other macrolides.

Conclusion: Infection with BP occurred frequently in these children with HIV, regardless of age, clinical, or immunologic status. Persistence and recurrence of infection was common. BP infection should be considered as a cause of upper respiratory tract symptoms and cough in children with HIV. After appropriate therapy, patients should be monitored for possible recurrence or persistence.