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Severe Recurrent Bacterial Pneumonia Among Children Living With HIV

Boettiger DC 1 , An VT 2 , Lumbiganon P 3 , Wittawatmongkol O 4 , Huu Truong K 5 , Chau Do V 2 Show all authors , Van Nguyen L 6 , Sun Ly P 7 , Kinikar A 8 , Ounchanum P 9 , Puthanakit T 10 , Kurniati N 11 , Kumarasamy N 12 , Kumara Wati D 13 , Chokephaibulkit K 4 , Jamal Mohamed TA 14 , Sudjaritruk T 15 , Nik Yusoff NK 16 , Siew Fong M 17 , Nallusamy RA 18 , Kariminia A 1 , TREAT Asia Pediatric HIV Observational Database

Affiliations 

  • 1 From the The Kirby Institute, UNSW Sydney, Australia
  • 2 Children Hospital 2, Ho Chi Minh City, Vietnam
  • 3 ¶ Division of Infectious Disease, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  • 4 Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 5 Children's Hospital 1, Ho Chi Minh City, Vietnam
  • 6 National Hospital of Pediatrics, Hanoi, Vietnam
  • 7 National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia
  • 8 BJ Medical College and Sassoon General Hospitals, Maharashtra, India
  • 9 ¶¶ Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  • 10 Department of Pediatrics and Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • 11 Cipto Mangunkusumo - Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
  • 12 Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
  • 13 Sanglah Hospital, Udayana University, Bali, Indonesia
  • 14 Department of Pediatrics, Women and Children Hospital Kuala Lumpur (WCHKL), Kuala Lumpur, Malaysia
  • 15 Department of Pediatrics, Faculty of Medicine, and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
  • 16 Hospital Raja Perempuan Zainab II, Kelantan, Malaysia
  • 17 Hospital Likas, Kota Kinabalu, Malaysia
  • 18 Penang Hospital, Penang, Malaysia
Pediatr Infect Dis J, 2022 May 01;41(5):e208-e215.
PMID: 35185140 DOI: 10.1097/INF.0000000000003494

Abstract

BACKGROUND: Bacterial pneumonia imparts a major morbidity and mortality burden on children living with HIV, yet effective prevention and treatment options are underutilized. We explored clinical factors associated with severe recurrent bacterial pneumonia among children living with HIV.

METHODS: Children enrolled in the TREAT Asia Pediatric HIV Observational Database were included if they started antiretroviral therapy (ART) on or after January 1st, 2008. Factors associated with severe recurrent bacterial pneumonia were assessed using competing-risk regression.

RESULTS: A total of 3,944 children were included in the analysis; 136 cases of severe recurrent bacterial pneumonia were reported at a rate of 6.5 [95% confidence interval (CI): 5.5-7.7] events per 1,000 patient-years. Clinical factors associated with severe recurrent bacterial pneumonia were younger age [adjusted subdistribution hazard ratio (aHR): 4.4 for <5 years versus ≥10 years, 95% CI: 2.2-8.4, P < 0.001], lower weight-for-age z-score (aHR: 1.5 for -2.0, 95% CI: 1.1-2.3, P = 0.024), pre-ART diagnosis of severe recurrent bacterial pneumonia (aHR: 4.0 versus no pre-ART diagnosis, 95% CI: 2.7-5.8, P < 0.001), past diagnosis of symptomatic lymphoid interstitial pneumonitis or chronic HIV-associated lung disease, including bronchiectasis (aHR: 4.8 versus no past diagnosis, 95% CI: 2.8-8.4, P < 0.001), low CD4% (aHR: 3.5 for <10% versus ≥25%, 95% CI: 1.9-6.4, P < 0.001) and detectable HIV viral load (aHR: 2.6 versus undetectable, 95% CI: 1.2-5.9, P = 0.018).

CONCLUSIONS: Children <10-years-old and those with low weight-for-age, a history of respiratory illness, low CD4% or poorly controlled HIV are likely to gain the greatest benefit from targeted prevention and treatment programs to reduce the burden of bacterial pneumonia in children living with HIV.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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