A guide for families and caregivers – Written by Cheelo Mwiinga
What is RSV and why does it matter?
Respiratory Syncytial Virus (RSV) is a common virus that infects the lungs and airways. By age two, nearly all children will have been infected with RSV at least once [1]. In most children it causes mild, cold-like symptoms e.g runny noses, cough and perhaps a low-grade fever. It is important to note however, that RSV infection is a leading cause of acute respiratory infections leading to a lot of hospitalisations in children globally. This is particularly a problem in children under five living with HIV because their natural defences are weakened and a common respiratory infection like RSV can quickly turn into a life-threatening condition. For families with CLHIV, an RSV infection can disrupt treatment routines, strain financial resources, and lead to emotional distress.
What happens if RSV is left untreated?
In a child with a robust immune system, RSV usually runs its course in a week or two. But if left untreated—or when the child’s immune system is compromised, it can lead to severe complications like bronchiolitis (inflamation of the small airways) or pneumonia. The outcome of inadequetely managed RSV infection differ between CLHIV and HIV uninfected children.
For the most part HIV uninfected children usually have mild symptoms which spontaneously resolve with supportive care at home. Even when hospitalised they recover fully with oxygen support, hydration, and monitoring. The main complication is bronchiolitis and pneumonia, which typically improve within several days of appropriate care. While some children may develop recurrent wheezing or asthma-like symptoms in years following severe RSV infection, life-threatening outcomes are relatively rare in previously healthy children.[2]
In CLHIV the picture is more concerning as RSV infection can rapidly progress from upper respiratory symptoms to severe Lower Respiratory Tract Infections. The weakened immune system cannot mount an effective response, allowing the virus to replicate unchecked causing extensive inflammation in the airways. This leads to increased need for respiratory support including ICU admission, higher mortality rates, prolonged illness and viral shedding as well as long term complications.
Watch out for redflags!! – When to Seek Help.
The most important thing a caregiver can do is watch for specific “red flags”. RSV symptoms usually peak around day three to five of the illness.
Take your child to the hospital immediately if you notice:
- Struggling to breathe: rapid/laboured breathing or grunting sounds with breathing.
- Fast Breathing: If they are breathing much faster than usual.
- Color Changes: A bluish or gray tint to the lips, tongue, or fingernails.
- Dehydration: If they are too tired to drink or have significantly fewer wet diapers.
- High Fever: Especially in infants under six months old.
Do not wait for symptoms to become severe! Early intervention can prevent progression to life-threatening disease.
What happens after discharge? My search for answers..
As a Paediatrician and budding researcher working with CLHIV, I’ve witnessed the urgent need for better RSV prevention and treatment. The evidence is clear: we must improve access to prevention tools, develop new therapeutics, and optimize HIV care. That’s why I’m deeply invested in the SUPPORT project where I am investigating RSV’s role in post-discharge mortality among CLHIV. I am currently enrolling participants and collecting data which will help identify critical gaps—and I’m committed to translating our findings into lives saved.
[1] World Health Organization. (2025, December 19). Respiratory syncytial virus (RSV). Retrieved from https://www.who.int/news-room/fact-sheets/detail/respiratory-syncytial-virus-(rsv)
[2] Jiang MY, Duan YP, Tong XL, et al. Clinical manifestations of respiratory syncytial virus infection and the risk of wheezing and recurrent wheezing illness: a systematic review and meta-analysis. World J Pediatr. 2023;19(11):1030-1040. doi:10.1007/s12519-023-00743-5
