Understanding the contribution of common childhood illnesses and opportunistic infections to morbidity and mortality in children living with HIV in resource-limited settings

Abstract

Objective Although antiretroviral treatment (ART) has reduced the incidence of HIV-related opportunistic infections among children living with HIV, access to ART remains limited for children, especially in resource-limited settings. This paper reviews current knowledge on the contribution of opportunistic infections and common childhood illnesses to morbidity and mortality in children living with HIV, highlights interventions known to improve the health of children, and identifies research gaps for further exploration. Design and Methods Literature review of peer-reviewed articles and abstracts combined with expert opinion and operational experience. Results Morbidity and mortality due to opportunistic infections has decreased in both developed and resource-limited countries. However, the burden of HIV-related infections remains high, especially in sub-Saharan Africa, where the majority of HIV-infected children live. Limitations in diagnostic capacity in resource-limited settings have resulted in a relative paucity of data on opportunistic infections in children. Additionally, the reliance on clinical diagnosis means that opportunistic infections are often confused with common childhood illnesses which also contribute to excess morbidity and mortality in these children. Although several preventive interventions have been shown to decrease opportunistic infection-related mortality, implementation of many of these interventions remains inconsistent. Conclusions In order to reduce opportunistic infection-related mortality, early ART must be expanded, training for front-line clinicians must be improved, and additional research is needed to improve screening and diagnostic algorithms.

Incidence of common opportunistic infections among HIV-infected children on ART at Debre Markos referral hospital, Northwest Ethiopia: a retrospective cohort study

“…Similarly, our finding is much higher than studies from the United States of America (4.99 per 100 person-years) [29], Latin America (1.1 per 100 person-years) [30], and Brazil (2.63 per 100 person-years) [10]. Literature also showed that HIV-related OIs remain high in resource limited settings; especially with SSA being disproportionately affected [9]. Developed countries have advanced technologies for early diagnosis, prevention, and management of OIs.…”

“…All HIV-infected people are susceptible to develop a wide range of OIs [6], but prevalence and incidence of HIV-associated OIs vary widely [7,8]. Most reports on the magnitude of OIs in HIV-infected children are from North America and Europe; while, in SSA, the true burden of OIs among HIV-children remains poorly documented [9] .…”

The burden of disease on HIV-infected orphaned and non-orphaned children accessing primary health facilities in a rural district with poor resources in South Africa: a cross-sectional survey of primary caregivers of HIV-infected children aged 5–18 years

“…Consequently, there is a lack of empirical data on when and why older children access primary health facilities for HIV testing and counseling. There is also a paucity of data on the burden of opportunistic infections in HIV-infected children in poor-resource settings [ 14 ]. Most HIV prevalence surveys either exclude older children [ 4 ], or report on children less than five years of age [ 15 , 16 ].…”

Trimethoprim–sulfamethoxazole (cotrimoxazole) desensitization in anHIV‐infected 5‐yr‐old girl

“…Opportunistic infections are a major cause of morbidity and mortality in HIV‐infected patients. Trimethoprim–sulfamethoxazole (TMP‐SMX) (cotrimoxazole) has been shown to dramatically reduce the risk of opportunistic infections, particularly Pneumocystis carinii pneumonia, and has been used extensively in their treatment and prevention . Since 2006, WHO has recommended cotrimoxazole preventive therapy for all HIV‐exposed infants and children born to mothers living with HIV, and continuing until cessation of risk of HIV transmission (cessation of breastfeeding) and infection can be exclude .…”