Page 301 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 2 of 5 Original Research

a longer duration of illness (p = 0.03), a longer hospital stay Ethical consideration
(p = 0.0004) and a higher mortality (p < 0.01). However, in a
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report by Sension et al. from Kinshasa, there were similar Permission to conduct the study was obtained from the
rates of pneumonia, diarrhoea and death in the HIV-positive Human Research Ethics Committee of the University of
and HIV-negative children. In South Africa, there have been Witwatersrand (Clearance Certificate No. M10104).
three studies comparing HIV-positive and HIV-negative
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children infected with measles. Morrow et al. concluded Results
that although HIV-infected patients were 1.6 times more A total of 51 adult patients with suspected measles were
likely to be hospitalised, there was no difference in death rate admitted to the IDU of CMJAH between 29 September 2009
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between the two groups. Le Roux et al. documented that the and 31 March 2010. Thirty-three (64.7%) of these patients
length of hospital admission was longer, the number of re- were confirmed to have measles by serology. In 12
admissions was greater and the odds ratio (OR) of death was patients (23.5%), measles serology was negative and six
seven times higher in the HIV-positive group. Pamacheche patients (11.8%) were not tested. Of the 33 patients confirmed
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et al. described the clinical profile of children admitted with to have measles by serology, 24 (72.7%) consented to a test
measles to a teaching hospital in Johannesburg. There were for HIV infection. These 24 patients were studied further.
two deaths, both in children that were HIV-negative.
Figure 1 shows the study population included in this
analysis.
Between 2009 and 2011, an outbreak of measles occurred in
South Africa that resulted in 18 431 laboratory-confirmed cases Of the 24 patients, 13 were female and 11 were male. The
being reported to the National Institute of Communicable mean (standard deviation) age of the HIV-positive group was
Diseases of the National Health Laboratory Service. During 28.1 (5.6) years and of the HIV-negative group was 29.6 (9.0)
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this outbreak, a number of cases were admitted to the adult years. Of the 24 patients, 18 patients (12 females) tested
Infectious Diseases ward at the Charlotte Maxeke Johannesburg seropositive for HIV infection. Of the entire group, only one
Academic Hospital (CMJAH) in Johannesburg and this HIV-positive patient reported a measles contact and two
afforded us the opportunity to describe the clinical features patients in the HIV-positive cohort remembered previously
and outcome of adult patients with measles comparing the being vaccinated against measles as a child.
HIV-positive and HIV-negative cases.

Methods Presenting features and examination findings are depicted in
Tables 1 and 2. There were no significant differences between
This was a retrospective record review of adult patients with the two patient groups. The median duration of symptoms
confirmed measles, who were admitted to the Infectious was 4 days (range: 1–7 days) in the HIV-positive group and
Diseases Unit (IDU) at the CMJAH during the peak of 3 days (range: 3–6 days) in the HIV-negative group.
the 2009 and 2011 South African measles outbreak. The
majority of cases occurred from week 37 in 2009 to week 24 in Laboratory investigations also revealed no significant
2010. The study period was 29 September 2009 to 31 March differences between the two groups (Table 3). In the HIV-
2010. positive group, the median CD4 count was 109 cells/mm³
(range: 18–599 cells/mm³) (16 patients had data), the HIV
The data collected included all available demographic and viral load (VL) was available for seven patients (with a
clinical features and laboratory parameters. Patients with median of 15 000 copies/mL) and three patients had a VL
clinical features suggestive of measles were confirmed to lower than the detectable limit. Eight patients (44.4%) were
have measles by serological testing, using the Enzygnost newly diagnosed with HIV infection on this presentation
Anti-Measles Virus/IgM assay (Dade-Behring, Marburg, and four patients were already on highly active antiretroviral
Germany). HIV testing, using a chemiluminescent therapy.
microparticle immunoassay for the simultaneous qualitative
detection of HIV p24 antigen and antibodies to HIV type 1
and/ or type 2 (ARCHITECT HIVAb/Ag Combo Calibrator, Admiƒed with suspected Excluded n = 18 (35.3%)
MV infec on n = 51
Abbott Laboratories, Wiesbaden, Germany), was offered to • Not tested for MV
all confirmed measles cases. The clinical characteristics and n = 6 (11.8%)
outcomes of these patients were compared in HIV-positive Confirmed posi ve • Nega ve MV serology
MV serology
and HIV-negative cases. Outcome measures were length of n = 33 (64.7%) n = 12 (23.5%)
hospital stay, complications and mortality.

The HIV-infected and HIV-uninfected groups were
compared using the Mann–Whitney U test for continuous MV and HIV MV without HIV Unknown HIV status
co-infec on
co-infec on
variables, and the Fisher’s exact (two-tailed) test for n = 18/33 (54.5%) n = 6/33 (18.2%) n = 9/33 (27.3%)
categorical variables. Analyses were done using GraphPad
InStat version 3. A p-value < 0.05 was considered to be MV, measles virus.
statistically significant. FIGURE 1: Flow diagram of the study patients.

http://www.sajhivmed.org.za 294 Open Access