Introduction

Bacterial infections in HIV-infected children often present in a manner similar to that seen in non-HIV-infected children although these infections occur more frequently, persist longer, have more frequent recurrences and disseminate more readily than in non-HIV-infected children. Because of this increased risk, the US Center for Disease Control and Prevention (CDC) added a new category of invasive bacterial infections to the list of pediatric AIDS-defining illnesses in 1987 [1]. When HIV-infected children present with a suspected bacterial infection, the differential diagnosis is large because the illnesses can be due to opportunistic and endemic infections. These infections include those due to viruses, fungi, mycobacteria, and parasites and can mimic the presentations typically associated with bacterial infections. In addition, bacteria that are unusual in the immunocompetent host may cause significant disease in immunosuppressed HIV-infected children.

Multiple immunologic abnormalities in HIV-infected children and additional factors in resource-poor countries that include malnutrition, micronutrient deficiencies and lack of adequate medical care result in increased susceptibility to infection. Furthermore, certain vaccines against bacterial agents or their toxins administered to HIV+ children often produce antibody titers that are lower and less persistent than that seen in non-HIV-infected children.

The antimicrobial regimens used in the treatment of many bacterial infections in HIV-infected children are often the same as for HIV-uninfected children. Suggested empiric regimens are listed in Table 30.1.