Management of community-acquired pneumonia in HIV-infected children

Abstract

Pneumonia is a major cause of childhood mortality and morbidity worldwide, particularly in low-income countries. Often, these are also the countries most affected by the HIV epidemic. Pneumonia is the leading cause of death in HIV-infected children and a major cause of hospitalization and healthcare utilization. A broader spectrum of organisms, such as Pneumocystis jiroveci and Gram-negative bacteria, cause pneumonia in HIV-infected children compared with uninfected children. Etiologic organisms have higher rates of antimicrobial resistance in HIV-infected children. Polymicrobial disease is more common in HIV-infected children and associated with an exponential increase in mortality rate. HIV-infected children develop more severe pneumonia and have a worse outcome than HIV-uninfected children. HIV-exposed but HIV-negative children are also at higher risk of severe pneumonia and death compared with HIV-unexposed children. Although case-management guidelines for childhood pneumonia have led to an overall decrease in global childhood morbidity and mortality, HIV-infected children continue to have unacceptably high treatment failure and case fatality rates despite adherence to these guidelines. Standard guidelines require adaptation for use in high HIV-prevalence areas. Specific preventive interventions, including chemoprophylaxis for P. jiroveci pneumonia or for TB and early initiation of highly active antiretroviral therapy, may significantly reduce the burden of pneumonia in HIV-infected children.

Keywords::

• acute respiratory infections
• children
• community acquired
• HIV
• pneumonia
• treatment

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.