Epidemiology of acute lower respiratory tract infection in HIV exposed uninfected infants

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Authors

Cohen, Cheryl
Moyes, Jocelyn
Tempia, Stefano
Groome, Michelle
Walaza, Sibongile
Pretorius, Marthi Andréa
Naby, Fathima
Mekgoe, Omphile
Kahn, Kathleen
Von Gottberg, Anne

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Publisher

American Academy of Pediatrics

Abstract

BACKGROUND : Increased morbidity and mortality from lower respiratory tract infection (LRTI) abstract has been suggested in HIV-exposed uninfected (HEU) children; however, the contribution of respiratory viruses is unclear. We studied the epidemiology of LRTI hospitalization in HIVunexposed uninfected (HUU) and HEU infants aged <6 months in South Africa. METHODS : We prospectively enrolled hospitalized infants with LRTI from 4 provinces from 2010 to 2013. Using polymerase chain reaction, nasopharyngeal aspirates were tested for 10 viruses and blood for pneumococcal DNA. Incidence for 2010–2011 was estimated at 1 site with population denominators. RESULTS : We enrolled 3537 children aged <6 months. HIV infection and exposure status were determined for 2507 (71%), of whom 211 (8%) were HIV infected, 850 (34%) were HEU, and 1446 (58%) were HUU. The annual incidence of LRTI was elevated in HEU (incidence rate ratio [IRR] 1.4; 95% confidence interval [CI] 1.3–1.5) and HIV infected (IRR 3.8; 95% CI 3.3–4.5), compared with HUU infants. Relative incidence estimates were greater in HEU than HUU, for respiratory syncytial virus (RSV; IRR 1.4; 95% CI 1.3–1.6) and human metapneumovirus–associated (IRR 1.4; 95% CI 1.1–2.0) LRTI, with a similar trend observed for influenza (IRR 1.2; 95% CI 0.8–1.8). HEU infants overall, and those with RSV-associated LRTI had greater odds (odds ratio 2.1, 95% CI 1.1–3.8, and 12.2, 95% CI 1.7–infinity, respectively) of death than HUU. CONCLUSIONS : HEU infants were more likely to be hospitalized and to die in-hospital than HUU, including specifically due to RSV. This group should be considered a high-risk group for LRTI.

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Keywords

Infants, Infection, Human immunodeficiency virus (HIV), HIV-exposed uninfected (HEU), Lower respiratory tract infection (LRTI), South Africa (SA)

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Citation

Cohen, C., Moyes, J., Tempia, S., Groome, M., Walaza, S., Pretorius, M., Naby, F., Mekgoe, O., Kahn, K., Von Gottberg, A., Wolter, N., Cohen, A.L., Von Mollendorf, C., Venter, M. & Madhi, S.A. Epidemiology of Acute Lower Respiratory Tract Infection in HIV-Exposed Uninfected Infants. Pediatrics. 2016;137(4):e20153272.