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Pulmonary manifestations in HIV seropositivity and malnutrition in Zimbabwe
1Department of Paediatrics, Mpilo Central Hospital, Bulawayo, Zimbabwe.
Insights
Adequate nutrition is crucial for young children, especially those with HIV (human immunodeficiency virus). Malnutrition significantly increases the risk of bacterial lung infections in these vulnerable children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- High rates of HIV (human immunodeficiency virus) infection and mortality in young children.
- Limited understanding of the interplay between HIV, malnutrition, and opportunistic infections in pediatric mortality.
Purpose of the Study:
- To investigate the prevalence of HIV, opportunistic infections, and bacterial lung infections in children under five who died at home.
- To determine the association between HIV serostatus, malnutrition, and the causes of death in this cohort.
Main Methods:
- Retrospective analysis of 184 children (aged ≤5 years) who died at home over 10 months.
- Assessment of nutritional status, HIV serostatus, and post-mortem examinations (necropsies).
- Microbiological analysis of lung aspirates and histopathological examination for infections.
Main Results:
- HIV antibody positivity was found in 66% (122/184) of the children.
- Opportunistic infections (e.g., Pneumocystis pneumonia) were exclusively seen in HIV-seropositive children (23%).
- Malnutrition affected 58% (106/184) and was significantly associated with bacterial lung infection, independent of HIV status.
Conclusions:
- Malnutrition is a critical factor exacerbating bacterial lung infections in HIV-infected children.
- Ensuring adequate nutrition is vital for reducing the risk of bacterial infections and improving outcomes in HIV-positive children.
- Public health interventions should prioritize nutritional support for young children in high-HIV prevalence settings.
Abstract:
Over a 10 month period 184 children, aged 5 years or less, who died at home had their nutritional status and HIV serostatus established; necropsies were also carried out. The HIV antibody test was positive in 122/184 (66%). Of the HIV seropositive children Pneumocystis carinii pneumonia was present in 19 (16%), cytomegalovirus pneumonia in nine (7%), and lymphoid interstitial pneumonitis in 11 (9%). Opportunistic infection was therefore seen in 28/122 (23%) of the seropositive cases but in none of the seronegative cases. Tuberculosis was present in 8/184 (4%): 6/122 (5%) in HIV seropositive and 2/62 (3%) in seronegative children. Lung aspirate showed positive bacterial isolates in 106/ 122 (86%) of HIV seropositive and 46/62 (74%) of seronegative children with Gram negative organisms predominating in both groups. Malnutrition was common and affected 106/184 (58%); positive growth was obtained in 98 (92%) of the malnourished children irrespective of their HIV serostatus. Malnutrition was significantly associated with bacterial lung infection after adjustment for the confounding effect of HIV status. No association was found between HIV serostatus and bacterial lung infection that could not be attributed to malnutrition at the time of death. The importance of adequate nutrition in reducing the risk of bacterial infection in HIV infected children is apparent.