Table 2.
Clinical and Epidemiologic Characteristics Associated With Being HIV-Infected Among Children <5 Years of Age Hospitalized With PIV-Associated Severe Acute Respiratory Illness at 4 Sentinel Surveillance Sites—South Africa, 2009–2014a
| Characteristic | All Parainfluenza Patients n/N (%) | HIV-Infected n/N (%) | HIV-Uninfected n/N (%) | Crude Odds Ratio (95% CI)b | Adjusted Odds Ratio (95% CI)b |
|---|---|---|---|---|---|
| Demographic characteristics | |||||
| Age group | |||||
| <1 year | 609/963 (63.2) | 37/80 (46.3) | 407/595 (68.4) | Reference | Reference |
| 1–4 years | 354/963 (36.8) | 43/80 (53.8) | 188/595 (31.6) | 2.3 (1.4–3.8) | 2.4 (1.4–4.0) |
| Male sex | 571/963 (59.3) | 42/80 (52.5) | 346/595 (58.2) | 1.2 (.8–1.9) | |
| Black race | 946/959 (98.6) | 79/80 (98.8) | 586/594 (98.7) | 0.9 (.1–6.5) | |
| Hospital site | |||||
| CHBAH | 622/963 (64.6) | 31/80 (38.8) | 369/595 (62.1) | Reference | Reference |
| Matikwane/Mapulaneng | 135/963 (14.0) | 20/80 (25.0) | 88/595 (14.8) | 2.5 (1.4–4.3) | 2.1 (1.2–3.8) |
| Edendale | 126/963 (13.1) | 14/80 (17.5) | 89/595 (15.0) | 1.8 (.9–3.7) | 1.7 (.8–3.6) |
| KTHC | 80/963 (8.3) | 15/80 (18.8) | 49/595 (8.2) | 3.4 (1.7–6.7) | 3.4 (1.7–6.8) |
| Year | |||||
| 2009 | 232/963 (24.1) | 15/80 (18.8) | 102/595 (17.1) | Reference | |
| 2010 | 146/963 (15.2) | 16/80 (20.0) | 98/595 (16.5) | 1.2 (.6–2.7) | |
| 2011 | 273/963 (28.4) | 22/80 (27.5) | 197/595 (33.1) | 0.9 (.4–1.8) | |
| 2012 | 146/963 (15.2) | 9/80 (11.3) | 93/595 (15.6) | 0.9 (.4–2.0) | |
| 2013 | 122/963 (12.7) | 11/80 (13.8) | 80/595 (13.5) | 1.1 (.5–2.6) | |
| 2014 | 44/963 (4.6) | 7/80 (8.8) | 25/595 (4.2) | 2.1 (.8–5.6) | |
| Coinfections and underlying medical conditions | |||||
| HIV infection | 80/675 (11.9) | Not applicable | Not applicable | Not applicable | |
| Underlying illness (excluding HIV and tuberculosis infection)c | 49/962 (5.1) | 4/80 (5.0) | 30/595 (5.0) | 1.2 (.4–3.7) | |
| Prematurity (<37 weeks gestational age at birth) | 36/962 (3.7) | 3/80 (3.8) | 25/595 (4.2) | 0.9 (.2–3.4) | |
| Bacterial or viral respiratory coinfection | |||||
| Pneumococcal coinfection on PCR | 66/734 (9.0) | 12/60 (20.0) | 23/439 (5.2) | 4.6 (2.0–10.4) | 4.8 (2.0–11.6) |
| Any viral respiratory coinfectiond | 567/915 (62.0) | 45/79 (57.0) | 333/563 (59.2) | 0.9 (.6–1.4) | |
| Respiratory syncytial virus | 88/963 (9.1) | 6/80 (7.5) | 50/595 (8.4) | 0.8 (.4–1.8) | |
| Influenza | 35/963 (3.6) | 2/80 (2.5) | 21/595 (3.5) | 0.9 (.2–3.0) | |
| Adenovirus | 211/859 (24.6) | 19/75 (25.3) | 121/538 (22.5) | 1.1 (.6–1.9) | |
| Rhinovirus | 313/963 (32.5) | 29/80 (36.3) | 179/595 (30.1) | 1.2 (.8–1.9) | |
| Enterovirus | 104/963 (10.8) | 7/80 (8.8) | 57/595 (9.6) | 0.9 (.4–1.9) | |
| Human metapneumovirus | 27/963 (2.8) | 2/80 (2.5) | 17/595 (2.9) | 0.7 (.2–3.0) | |
| Clinical presentation and course | |||||
| Symptoms ≥3 days before admission | 271/952 (28.5) | 26/78 (33.3) | 169/587 (28.8) | 1.2 (.7–1.8) | |
| Fever (temperature ≥38°C) | 697/958 (72.8) | 59/80 (73.8) | 423/591 (71.6) | 1.1 (.6–1.8) | |
| Admission to intensive care | 11/947 (1.2) | 0/77 (0) | 10/589 (1.7) | 0.5 (–3.4)e | |
| Oxygen therapy | 332/947 (35.1) | 33/77 (42.9) | 203/589 (34.5) | 1.4 (.8–2.2) | |
| Antibiotics prescribed on admission | 859/941 (91.3) | 76/77 (98.7) | 533/581 (91.7) | 2.8 (.6–13.3) | |
| Outcome | |||||
| Prolonged hospitalization (≥3 days) | 464/945 (49.1) | 51/77 (66.2) | 295/586 (50.3) | 1.8 (1.1–2.9) | |
| In-hospital death (case/fatality ratio) | 15/952 (1.6%) | 3/78 (3.9) | 7/591 (1.2) | 2.5 (.7–9.3) | |
Abbreviations: CHBAH, Chris Hani-Baragwanath Academic Hospital; CI, confidence interval; HIV, human immunodeficiency virus; KTHC, Klerksdorp-Tshepong Hospital Complex; PCR, polymerase chain reaction; PIV, parainfluenza virus.
a Adjusted odds ratios are only shown if those variables were included in the final multivariable model.
b Crude and adjusted odds ratios used a dataset where multiple imputation was used to complete variables that were statistically significantly associated with HIV status or had high rates of missingness: age group, hospital site, and pneumococcal coinfection.
c Asthma, other chronic lung disease, chronic heart disease, liver disease, renal disease, diabetes mellitus, obesity, immunocompromising conditions (excluding HIV infection), neurologic disease, prematurity, kwashiorkor. These conditions were considered absent if recorded as such or if there was no direct mention of the condition in the medical records.
d Coinfection with PIV and ≥1 of the following: adenovirus, enterovirus, influenza A and B viruses, respiratory syncytial virus, human metapneumovirus, and rhinovirus. Adenovirus testing was not done August–October 2009.
e Nonmulitply imputed dataset used; exact logistic regression for zero cells unable to be used with multiple imputation.