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HIV seropositivity and cholera in refugee children from Rwanda.

During the cholera outbreak of July 1994 in Goma (Zaire) the results of 143 tests for human immunodeficiency virus (HIV) which had been performed previously by orphanage staff on Rwandese orphans were used in a study defining the mortality risk of cholera according to HIV serostatus and age. All serum samples were tested using two different commercial immunoenzymatic assays; if results were uniform the sera were not tested further. Sera with discordant results were confirmed by a commercial Western blot. The children ranged in age from 12 months to 15 years. Thirteen were under 18 months. Seven were HIV-seropositive (4.9% global prevalence rate); three (23.1%) were younger than 18 months and four (3.1%) were older than 18 months. Seven of the 143 children died from cholera; four were HIV-seropositive (57% specific mortality rate) and three were HIV-seronegative (2.4% specific mortality rate). The risk ratio (RR) of death from cholera is significantly higher for a HIV-seropositive child (RR 25.9; range 7.1-94; P < 0.001); however the mortality risk of cholera according to HIV serological status is significantly linked to age. For children under 18 months of age the mortality rates for HIV-seropositive and HIV-seronegative children are 100% and 10% respectively. Although a RR cannot be estimated because of the presence of a zero value in one cell there is a statistically significant difference (Fishers exact test P = 0.01). The mortality rates are not statistically different for those over 18 months of age (P = 0.09) between HIV-positive and HIV-negative children (25% vs. 1.6%.; RR 15.7; range 1.7-139.9).