Pneumocystis carinii and cytomegalovirus infections in severely ill, HIV-infected African infants

Unlike in the industrialized world, in which Pneumocystis carinii and cytomegalovirus (CMV) are major respiratory opportunistic organisms, the causes of severe pneumonia, which accounts for much of the mortality in HIV-infected infants in developing countries, are not known, although tuberculosis has been associated with HIV in adults. We report on post-mortem lung and liver biopsies obtained soon after death from 36 HIV-infected infants and 36 HIV-uninfected matched controls who had been admitted with severe pneumonia to an ICU. Nineteen of the HIV-infected infants were classified by WHO criteria as having AIDS and 17 'symptomatic HIV'. P. carinii and CMV were detected significantly more frequently in lung tissue from the AIDS patients (14 of 18 samples tested, p < 0.01; 14 of 18 samples tested, p < 0.01, respectively) as compared with matched controls. P. carinii was detected in two of 13 lung biopsies from symptomatic HIV infants, but in none of the controls. Lung tissue obtained from AIDS patients had P. and CMV more frequently (p<0.01, p<0.01, respectively) than that from symptomatic HIV patients. CMV was also detected in excess in liver tissue from AIDS infants (five of 18 samples) as compared with that from symptomatic HIV (0 of 16; p = 0.03) and matched controls (two of 34; p = 0.04). Ante-mortem investigations revealed more CMV infections in AIDS patients (four of 19) than in matched controls (0 of 36; p < 0.01). Tuberculosis was detected in post-mortem lung tissue from only one patient with symptomatic HIV infection. The finding that pathogens (P. carinii, CMV) most frequently detected in seriously ill African infants with HIV/AIDS are similar to those in their counterparts from industrialized countries has implications for improved management in the former.