HIV infection remains a major R428 challenge to clinicians with 26% of children admitted with acute gastroenteritis being identified as HIV-infected despite only an estimated 6.47% of the enrolled cohort being HIV-infected. Incidence of acute gastroenteritis was highest in the under 6 months age group, with almost 90% of admissions occurring in those under 2 years of age. The overall incidence rate was five times greater in HIV-infected children compared to those children

who were HIV-uninfected, and estimates of rotavirus incidence were two fold higher in HIV-infected compared to HIV-uninfected children. A longer duration of hospitalisation and higher in-hospital case fatality rates were observed in HIV-infected compared to HIV-uninfected children. Although rotavirus testing was not undertaken in our study, we can make some inferences on rotavirus disease burden in this cohort based on rotavirus data available from PD0325901 clinical trial South Africa. In South Africa a review of available literature found that rotavirus disease occurs early in life, with more than 95% of rotavirus cases occurring in children less than 18 months of age [7]. Similarly in a recent study conducted in Gauteng and North West Provinces of South Africa, 90%

of children hospitalised for rotavirus diarrhoea were less than 18 months of age and 95% were less than 2 years of age [8]. In our study the burden of disease due to severe acute gastroenteritis was greatest in young children, with incidence decreasing with increasing age. Eighty-nine percent of admissions for acute gastroenteritis occurred in children less than isothipendyl 2 years of age, with 31% in those less than 6 months. Thus rotavirus is expected to contribute to a significant proportion

of acute gastroenteritis in our cohort, based on the age distribution of hospitalised children. Based on data from surveillance programmes studies, rotavirus was identified as the most important cause of severe acute gastroenteritis accounting for approximately 40% of hospitalisations for diarrhoea in children less than 5 years [12]. Surveillance in Dr. George Mukhari Hospital, a tertiary care facility in South Africa, showed that approximately 23% of children hospitalised for diarrhoea had stool specimens positive for rotavirus and estimated that 1 in 43–62 children were likely to be hospitalised due to rotavirus diarrhoea by 2 years of age [8], reflecting the public health impact of this disease. A review of rotavirus infection in HIV-infected children that these children do not have more frequent or more severe rotavirus disease compared to HIV-uninfected children [13]. However, the absolute burden of severe rotavirus disease may be greater among HIV-infected children than HIV-uninfected children, as has been shown with respiratory viral infections [14].