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Pneumonia risk significantly greater among children with HIV
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HIV-infected children were significantly more likely to die from pneumonia in developing countries where the highest incidence and mortality from pneumonia have been reported, according to recent findings.
“The high incidence of pneumonia globally has been strongly linked to poverty, poor living conditions, poor health services, malnutrition and HIV infection, especially in Africa and southeast Asia,” Evropi Theodoratou, PhD, of the University of Edinburgh Medical School in the United Kingdom, and colleagues wrote. “HIV-infected children not receiving antiretroviral treatment have poor response to empirical treatment targeted predominantly against Haemophilus influenzae type b and Streptococcus pneumoniae and need broad-spectrum antibiotics to cover a range of microbial infections.”
To ascertain the role of HIV in pneumonia incidence and mortality in high pneumonia-burden countries, the researchers performed a systematic review of studies published in Medline, Embase and Global Health from January 1980 through August 2013.
The researchers estimated nationwide pneumonia incidence and mortality among children aged younger than 5 years using two analysis models that combined multiple risk factors for pediatric pneumonia hospital admission and mortality, including HIV infection. Using these estimates, the researchers calculated the total pneumonia episodes and deaths that occurred among HIV-infected children in 133 high pneumonia-burden countries in 2010.
Children aged younger than 5 years with an HIV infection were six times more likely to die from pneumonia (OR=5.9; 95% CI, 2.7–12.7), and more likely to be hospitalized for all-cause pneumonia than children without HIV (OR=6.5; 95% CI, 5.9–7.2).
Meta-analysis demonstrated that approximately 1.4 million pneumonia episodes occurred among HIV-infected children in low-income countries in 2010, and an estimated 88,000 HIV-positive children died of pneumonia. Of these, the researchers found that 1.2 million pneumonia episodes and 85,400 deaths could be directly attributed to HIV.
“We have shown that, although only about 1% of childhood pneumonia morbidity and 9% of mortality from childhood pneumonia are attributable to HIV worldwide, in the WHO African region, about 3% of pneumonia episodes and 17% of pneumonia deaths are attributable to HIV,” Theodoratou and colleagues wrote.
The researchers noted that in countries with the highest HIV burden — Lesotho, Swaziland and Zimbabwe — up to 20% of all pneumonia cases and 60% of pneumonia deaths occur in HIV-infected children.
“Our estimates have important policy implications. Management of pneumonia in HIV-infected children needs a multipronged integrated approach both from national governments and international agencies,” Theodoratou and colleagues wrote. “Case ascertainment (of both pneumonia and HIV by PCR virological testing) needs to be strengthened in primary care, and antiretroviral therapy in pregnant women and young children need to be rapidly scaled up, along with co-trimoxazole prophylaxis coverage. Priority countries that have not yet introduced pneumococcal conjugate vaccine should consider doing so, at least for HIV-infected children.”
Disclosure: One of the researchers reports having speakers bureau positions and advisory board relationships with GlaxoSmithKline, Medimmune, Novartis, Pfizer and Sanofi-Aventis.
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