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Measles infection in HIV-infected African infants
1Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA. rperry@welchlink.welch.jhu.edu
Insights
Measles poses a greater risk for HIV-positive infants in Africa, with higher mortality and malnutrition rates. Further research is needed on optimal measles immunization timing for these vulnerable children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- Measles remains a significant cause of child mortality in developing nations.
- The interaction between measles infection and human immunodeficiency virus (HIV) in children, particularly in Africa, requires further investigation.
Purpose of the Study:
- To review the epidemiology of measles in HIV-infected children in Africa.
- To assess the impact of HIV status on measles outcomes and complications in infants and children.
Main Methods:
- Review of epidemiological data on measles in hospitalized infants.
- Analysis of an autopsy study correlating measles with mortality in HIV-positive children.
- Examination of a cohort study on measles incidence in infants born to HIV-positive mothers.
Main Results:
- HIV-positive infants hospitalized with measles showed higher rates of malnutrition and death compared to HIV-negative infants.
- Rates of pneumonia and diarrhea were similar between HIV-positive and HIV-negative infants with measles.
- Measles was associated with mortality in HIV-positive children over 15 months of age.
- Infants of HIV-positive women had a higher incidence of measles before 9 months, but complication rates were similar.
Conclusions:
- HIV infection appears to increase the severity of measles outcomes, particularly mortality, in African infants.
- The optimal age for measles vaccination in the context of the HIV epidemic needs further study.
- Incomplete data on infant HIV status and measles serology limit definitive conclusions.
Abstract:
Measles infection remains a serious threat to child survival in the developing world despite vaccination and treatment with vitamin A. This report reviews the epidemiology of measles in HIV-infected children in Africa. In hospitalized infants, the rate of malnutrition before measles and the rate of death after measles are both higher in HIV-positive than in HIV-negative infants. However, the rates of pneumonia and diarrhea in infants hospitalized with measles are the same in HIV-positive as in HIV-negative infants. In an autopsy study, measles was associated with death in HIV-positive children, only for those over 15 months of age. A cohort study found that infants of HIV-positive women were more likely than infants of HIV-negative women to have measles before 9 months of age, although the rates of complications did not differ between the two groups. The HIV status of the infants and the measles serology were too incomplete to draw firm conclusions, though only 1 of 54 infants tested was seropositive for measles at 6 months of age. In the context of the HIV epidemic, further work is needed to determine the risk of measles and its complications in HIV-positive infants and the optimal age of measles immunization.