Epidemiology of Acute Lower Respiratory Tract Infection in HIV-Exposed Uninfected Infants

• Published in: Pediatrics (Evanston) Vol. 137; no. 4
• Main Authors: Cohen, Cheryl, Moyes, Jocelyn, Tempia, Stefano, Groome, Michelle, Walaza, Sibongile, Pretorius, Marthi, Naby, Fathima, Mekgoe, Omphile, Kahn, Kathleen, von Gottberg, Anne, Wolter, Nicole, Cohen, Adam L, von Mollendorf, Claire, Venter, Marietjie, Madhi, Shabir A
• Format: Journal Article
• Language: English
• Published: United States 01.04.2016
• Subjects: Acute Disease; Analysis of Variance; Female; HIV Infections; Hospital Mortality; Hospitalization - statistics & numerical data; Humans; Incidence; Infant; Influenza, Human - epidemiology; Male; Metapneumovirus - isolation & purification; Paramyxoviridae Infections - epidemiology; Prospective Studies; Respiratory Syncytial Viruses - isolation & purification; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - mortality; Risk Factors; South Africa - epidemiology; Virus Diseases - epidemiology; South Africa
• ISSN: 1098-4275
• DOI: 10.1542/peds.2015-3272

Increased morbidity and mortality from lower respiratory tract infection (LRTI) 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 HIV-unexposed uninfected (HUU) and HEU infants aged <6 months in South Africa. 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. 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. 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.