Global, regional, and national estimates of pneumonia burden in HIV-infected children in 2010: a meta-analysis and modelling study

Abstract

SummaryBackgroundGlobally, pneumonia is a leading cause of mortality and morbidity in children younger than 5 years. Underlying HIV infection is an important risk factor for pneumonia morbidity and mortality in children. There are, however, no global or country level estimates of pneumonia burden in HIV-infected children. We assessed the role of HIV in pneumonia incidence and mortality and estimated the number of pneumonia cases and deaths in HIV-infected children younger than 5 years in 133 high pneumonia-burden countries in 2010.MethodsWe estimated the risk of hospital admission and case fatality rate caused by pneumonia in HIV-infected children compared with HIV-uninfected children from a systematic review of studies published in Medline, Embase, and Global Health between Jan 1, 1980, and Aug 31, 2013. We estimated nationwide pneumonia incidence and mortality with two different models that incorporated several risk factors for paediatric pneumonia hospital admission and mortality (including HIV infection). We then estimated the number of pneumonia episodes and deaths that occurred in HIV-infected children in 2010.FindingsThe odds ratio (OR) for hospital admission for all-cause pneumonia in HIV-infected children compared with HIV-uninfected children was 6·5 (95% CI 5·9–7·2). The risk of death was higher in children with pneumonia and HIV compared with those with pneumonia only (OR 5·9, 95% CI 2·7–12·7). In 2010, 1·4 million pneumonia episodes (uncertainty range [UR] 0·6 million to 3·3 million) and 88 000 pneumonia deaths (UR 47 400–153 000) occurred in HIV-infected children in low-income countries. Of these, 1·2 million pneumonia episodes (UR 0·5 million–2·7 million) and 85 400 deaths (UR 46 000–147 300) were directly attributable to HIV. 1·3 million (90%) pneumonia episodes and 82 400 (93%) pneumonia deaths in HIV-infected children aged younger than 5 years occurred in the WHO African region.InterpretationGlobally, a small proportion of pneumonia episodes and pneumonia deaths occur in HIV-infected children. However, in the highest HIV-burden countries in sub-Saharan Africa (ie, Swaziland, Lesotho, and Zimbabwe) up to a fifth of all pneumonia cases and 60% of pneumonia deaths occur in HIV-infected children. In these countries, major reductions in child pneumonia mortality can be achieved only if the systemic challenges plaguing the health system (poor coverage of early infant testing for HIV, of antiretroviral drugs in pregnant women and young children, of co-trimoxazole prophylaxis, and of pneumococcal vaccination) can be overcome.FundingWHO.

Mortality and its risk factors in Malawian children admitted to hospital with clinical pneumonia, 2001–12: a retrospective observational study

“…Scenarios were generated to assess the effect of possible trends of HIV prevalence and case fatality rates in HIV-negative cases on overall case fatality rates, assuming odds of mortality in HIV-positive pneumonia cases 5∙9 times higher than the odds of mortality in HIV-negative cases 17 in five scenarios and changing the odds in another scenario.…”

Advances in the diagnosis of pneumonia in children

“…A meta-analysis reported that the incidence of and mortality from pneumonia in children infected with HIV is about six times higher than in those not infected with HIV. 20 Infants who have been exposed to HIV but are not infected (those born to HIV infected mothers who are HIV negative owing to effective interventions for preventing mother-to-child transmission) are also increasingly recognized as being more vulnerable to pneumonia. These with a gold standard of pneumonia defined by computed tomography, and only one study provided the diagnostic accuracy of ultrasound and chest radiography against computed tomography for pneumonia.…”

Bronchiectasis and other chronic lung diseases in adolescents living with HIV

“…HIV is associated with an increased risk of tuberculosis, and recurrent viral and bacterial pulmonary infections [7**,17,23,24,25*,26]. However, some data suggest that HIV predisposes to bronchiectasis independently of infection, likely due to HIV-mediated defects in innate immunity and accompanying airway neutrophilic inflammation [17,21*,22*,27].…”

“…Increasing availability of ART and co-trimoxazole have resulted in a decline in the incidence of bacterial pneumonia, pulmonary tuberculosis, and PCP [54,55]. In LMICs, pulmonary infections remain common despite decreases in incidence, and risk of pulmonary infections is particularly high among those with delayed diagnosis and treatment of HIV [26,56*]. …”