A new study said HIV-positive children are much more likely to die from pneumonia than children who are not infected with the AIDS virus. It’s estimated there are more than three million children under age 14 living with HIV. The vast majority are in sub-Saharan Africa. Researchers said deaths from pneumonia among HIV-positive children could be dramatically reduced by expanding current treatments.
Dr. Harish Nair led the study to better understand the scope of the problem. He’s with the University of Edinburgh’s Center for Population Health Sciences. “We’ve been working on pneumonia estimates for over a decade now. And we realized that there are no estimates for pneumonia and HIV-infected children. We all know that pneumonia is an important cause of morbidity and mortality in HIV-infected children,” he said.
While it was clear pneumonia threatened HIV-positive children, Nair says it was not known just how many were actually affected. The global study his team conducted – the first of its kind – shed light on the problem. He said, “What we see is globally of the 116 million episodes of pneumonia occurring each year in under-five children, one-point-four-million episodes are in HIV-infected children. And of the 920,000 deaths from pneumonia in under-five children we find there are 88,000 deaths in HIV-infected children.”
Africa and South Asia are the worst regions for HIV-positive children dying from pneumonia. Their weakened immune systems put them at greater risk. Pneumonia has been linked to poverty, poor living conditions and inadequate health services. “To put this into perspective,” he said, “a child who has HIV and who develops pneumonia has a 36-fold higher risk of dying compared to a healthy child, who is HIV uninfected.”
The study was commissioned by the World Health Organization and published in The Lancet Infectious Diseases journal. The findings will be used to develop new care and treatment guidelines. Nair said that AIDS drugs keep patients healthier and make them less susceptible to pneumonia. But he says while sub-Saharan Africa now has greater access to AIDS drugs, most of them are for adults. “Even now, the antiretroviral coverage in young children remains pretty low. For example, the data for coverage of antiretrovirals in children under five years is not available. The other problem is that the antiretroviral coverage in children across the zero-to-14-year age group remains pretty low. It’s about only 29 percent in these 22 high priority global action plan countries.”
Dr. Nair said opportunistic infections are very common in children with HIV. However, he said very few – only about 30 percent – receive the drug Co-trimoxazole. The drug has been shown to lower the overall infection rate, not only for pneumonia, but also for malaria and sepsis. He also said children with HIV should be a top priority when administering the pneumococcal vaccine. “There have been studies which have shown that in HIV-infected children once you’ve introduced the pneumococcal vaccine the incidence of pneumonia decreased sharply,” he said.
He added that diagnosing pneumonia in HIV-positive children needs to be “strengthened at the primary care level.” Nair also recommended “rapidly scaling up” antiretroviral therapy for pregnant women and young children with HIV.
