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Severe Recurrent Bacterial Pneumonia Among Children Living With HIV

David C Boettiger1,2,3, Vu Thien An4, Pagakrong Lumbiganon5

  • 1From the The Kirby Institute, UNSW Sydney, Australia.

The Pediatric Infectious Disease Journal
|February 21, 2022
PubMed

Insights

Severe recurrent bacterial pneumonia disproportionately affects children with HIV. Younger age, low weight-for-age, prior respiratory illness, low CD4%, and detectable HIV viral load are key risk factors.

Area of Science:

  • Pediatric Infectious Diseases
  • HIV/AIDS Research
  • Respiratory Medicine

Background:

  • Bacterial pneumonia poses a significant health challenge for children living with HIV, leading to substantial morbidity and mortality.
  • Effective prevention and treatment strategies for bacterial pneumonia in this population remain underutilized.

Purpose of the Study:

  • To investigate clinical factors associated with severe recurrent bacterial pneumonia in children living with HIV.
  • To identify risk factors that can inform targeted prevention and treatment strategies.

Main Methods:

  • Analysis of data from the TREAT Asia Pediatric HIV Observational Database.
  • Inclusion criteria: children initiating antiretroviral therapy (ART) on or after January 1st, 2008.
  • Competing-risk regression was used to assess factors linked to severe recurrent bacterial pneumonia.

Main Results:

  • A total of 3,944 children were analyzed, with 136 cases of severe recurrent bacterial pneumonia.
  • Key associated factors included younger age (<5 years), lower weight-for-age z-score, pre-ART diagnosis of severe recurrent bacterial pneumonia, history of lymphoid interstitial pneumonitis or chronic HIV-associated lung disease, low CD4% (<10%), and detectable HIV viral load.
  • The rate of severe recurrent bacterial pneumonia was 6.5 events per 1,000 patient-years.

Conclusions:

  • Children under 10 years old with low weight-for-age, a history of respiratory illness, low CD4%, or poorly controlled HIV infection are at higher risk.
  • Targeted prevention and treatment programs are crucial to mitigate the impact of bacterial pneumonia in children living with HIV.
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