Page 300 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 5 Original Research

Measles in adults: A comparison of hospitalised

HIV-infected and HIV-uninfected patients

Authors: Background: Although measles is traditionally a childhood illness, there are an increasing
Nina E. Diana number of adult cases. Despite both measles and HIV infection being endemic in sub-Saharan
1,3
Charles Feldman
2,3
Africa, there are little data regarding outcomes in co-infected patients.
Affiliations:
1 Division of Nephrology, Objectives: Compare demographic, clinical, laboratory and radiographic features, as well as
Department of Internal outcome (length of hospital stay, complications and mortality) between HIV-infected and HIV-
Medicine, Charlotte Maxeke uninfected adult patients admitted with confirmed measles.
Johannesburg Academic
Hospital, Johannesburg, Methods: We conducted a retrospective record review of adult patients with confirmed measles
South Africa who were admitted to the Infectious Diseases Unit at the Charlotte Maxeke Johannesburg
Academic Hospital during the peak of the 2009 and 2010 South African measles outbreak. The
2 Division of Pulmonology,
Department of Internal data collected included demographic, clinical and laboratory parameters, as well as outcomes.
Medicine, Charlotte Maxeke Results: Of the 33 confirmed measles cases admitted, 24 patients were tested for HIV infection and
Johannesburg Academic
Hospital, Johannesburg, 18 tested seropositive. There were no significant differences in the demographics, clinical findings
South Africa or laboratory data when comparing the HIV-positive and HIV-negative cases. Serious clinical
manifestations were seen more frequently in HIV-positive patients (odds ratio [OR] 5, 95%
3 Faculty of Health Sciences, confidence interval [CI] 0.48–51.8, p = 0.34). One of the six patients testing HIV-negative developed
University of the pneumonia, while six of the 18 HIV-positive patients had a course complicated by pneumonia.
Witwatersrand,
Johannesburg, South Africa Five of these HIV-positive patients required admission to the intensive care unit, three developing
respiratory failure necessitating mechanical ventilation. HIV-positive patients had several other
Corresponding author: manifestations, including acute kidney injury, purulent conjunctivitis, pancreatitis and encephalitis.
Nina Diana, HIV-positive patients had a significantly longer hospital stay (p = 0.03). There were three deaths in
[email protected]
the HIV-positive group, but none in the HIV-negative group (OR 2.9, 95% CI 0.13–65.3, p = 0.55).
Dates:
Received: 22 June 2018 Conclusion: Our study provides data on the largest series of hospitalised adults infected with
Accepted: 22 Feb. 2019 HIV and co-infected with measles. More severe consequences seemed to occur in hospitalised
Published: 13 Aug. 2019 HIV-positive patients.
How to cite this article: Keywords: Measles; Adults; Complications; Human immunodeficiency virus; Infectious
Diana NE, Feldman C. diseases.
Measles in adults: A
comparison of hospitalised
HIV-infected and HIV-
uninfected patients. S Afr J Introduction
HIV Med. 2019;20(1), a877. 1
https://doi.org/10.4102/ Measles is one of the most contagious of all human viruses, and infects approximately 10 million
sajhivmed.v20i1.877 people annually, with an estimated mortality of 134 200 in 2015, occurring mainly in developing
countries. Although it is historically a childhood illness, reports have highlighted an increasing
2
1
Copyright: frequency of measles occurring in young adults. 3,4,5,6 With the incorporation of measles
© 2019. The Authors.
Licensee: AOSIS. This work vaccination into routine childhood vaccination programmes, there has been a ‘shift of disease
7,8
is licensed under the burden’. It now occurs more commonly in older patients who missed vaccination as children.
Creative Commons In addition, protection induced by the measles vaccine also seems to wane over a period of
Attribution License. years (secondary vaccine failure), with the length of protection having been estimated to be
approximately 25 years. 9
Factors affirming the theory that the HIV epidemic may enhance dissemination of measles include
the high rates of primary and secondary measles vaccine failure in HIV-infected persons, 10,11,12,13,14
atypical presentations of measles resulting in delayed diagnosis in HIV-infected individuals, 15,16
as well as the association of HIV infection with prolonged measles viral shedding and delayed
17
Read online: clearance of the measles virus (MV). Serious complications have been described in HIV-positive
Read online:
Scan this QR
Scan this QR patients co-infected with measles. 18,19,20,21,22,23
code with your
code with your
smart phone or
smart phone or
mobile device All studies comparing HIV-positive and HIV-negative patients infected with measles have been
mobile device
to read online.
to read online.
conducted in the paediatric population only. Moss et al. reported HIV-positive children to have
24
http://www.sajhivmed.org.za 293 Open Access