Outcome of human immunodeficiency virus-exposed and -infected children admitted to a pediatric intensive care unit for respiratory failure.

OBJECTIVE: Acute severe pneumonia with respiratory failure in human immunodeficiency virus-infected and -exposed infants carries a high mortality. Pneumocystis jiroveci is one cause, but other organisms have been suggested to play a role. Our objective is to describe the coinfections and treatment strategies in a cohort of human immunodeficiency virus-infected and -exposed infants with respiratory failure and acute respiratory distress syndrome, in an attempt to improve survival. DESIGN: Prospective intervention study. SETTING: Steve Biko Academic Hospital, Pretoria, South Africa. PATIENTS: Human immunodeficiency virus-exposed infants with respiratory failure and acute respiratory distress syndrome were recruited into the study. INTERVENTIONS: All infants were treated with routine therapy for Pneumocystis jiroveci and bacterial coinfection. However, in addition, all infants received ganciclovir from admission until the cytomegalovirus viral load result was demonstrated to be