Matthew S Kelly1, Kathleen E Wirth2, Andrew P Steenhoff3, Coleen K Cunningham4, Tonya Arscott-Mills5, Sefelani C Boiditswe6, Mohamed Z Patel7, Samir S Shah8, Rodney Finalle9, Ishmael Makone10, Kristen A Feemster11. 1. Botswana-UPenn Partnership, Gaborone, Botswana Divisions of Global Health Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina. 2. Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts. 3. Botswana-UPenn Partnership, Gaborone, Botswana Divisions of Global Health Infectious Diseases, The Children's Hospital of Philadelphia, Pennsylvania Perelman School of Medicine, University of Pennsylvania, Philadelphia. 4. Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina. 5. Botswana-UPenn Partnership, Gaborone, Botswana Perelman School of Medicine, University of Pennsylvania, Philadelphia. 6. Botswana-UPenn Partnership, Gaborone, Botswana. 7. University of Botswana School of Medicine, Gaborone. 8. Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Ohio. 9. Divisions of Global Health Perelman School of Medicine, University of Pennsylvania, Philadelphia. 10. Ministry of Health, Gaborone, Botswana. 11. Divisions of Global Health Infectious Diseases, The Children's Hospital of Philadelphia, Pennsylvania Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Abstract
BACKGROUND: Human immunodeficiency virus (HIV)-exposed, uninfected (HIV-EU) children are at increased risk of infectious illnesses and mortality compared with children of HIV-negative mothers (HIV-unexposed). However, treatment outcomes for lower respiratory tract infections among HIV-EU children remain poorly defined. METHODS: We conducted a hospital-based, prospective cohort study of N = 238 children aged 1-23 months with pneumonia, defined by the World Health Organization. Children were recruited within 6 hours of presentation to a tertiary hospital in Botswana. The primary outcome--treatment failure at 48 hours--was assessed by an investigator blinded to HIV exposure status. RESULTS: Median age was 6.0 months; 55% were male. One hundred fifty-three (64%) children were HIV-unexposed, 64 (27%) were HIV-EU, and 20 (8%) were HIV-infected; the HIV exposure status of 1 child could not be established. Treatment failure at 48 hours occurred in 79 (33%) children, including in 36 (24%) HIV-unexposed, 30 (47%) HIV-EU, and 12 (60%) HIV-infected children. In multivariable analyses, HIV-EU children were more likely to fail treatment at 48 hours (risk ratio [RR]: 1.83, 95% confidence interval [CI]: 1.27-2.64, P = .001) and had higher in-hospital mortality (RR: 4.31, 95% CI: 1.44-12.87, P = .01) than HIV-unexposed children. Differences in outcomes by HIV exposure status were observed only among children under 6 months of age. HIV-EU children more frequently received treatment with a third-generation cephalosporin, but this did not reduce the risk of treatment failure in this group. CONCLUSIONS: HIV-EU children with pneumonia have higher rates of treatment failure and in-hospital mortality than HIV-unexposed children during the first 6 months of life. Treatment with a third-generation cephalosporins did not improve outcomes among HIV-EU children.
BACKGROUND:Human immunodeficiency virus (HIV)-exposed, uninfected (HIV-EU) children are at increased risk of infectious illnesses and mortality compared with children of HIV-negative mothers (HIV-unexposed). However, treatment outcomes for lower respiratory tract infections among HIV-EU children remain poorly defined. METHODS: We conducted a hospital-based, prospective cohort study of N = 238 children aged 1-23 months with pneumonia, defined by the World Health Organization. Children were recruited within 6 hours of presentation to a tertiary hospital in Botswana. The primary outcome--treatment failure at 48 hours--was assessed by an investigator blinded to HIV exposure status. RESULTS: Median age was 6.0 months; 55% were male. One hundred fifty-three (64%) children were HIV-unexposed, 64 (27%) were HIV-EU, and 20 (8%) were HIV-infected; the HIV exposure status of 1 child could not be established. Treatment failure at 48 hours occurred in 79 (33%) children, including in 36 (24%) HIV-unexposed, 30 (47%) HIV-EU, and 12 (60%) HIV-infectedchildren. In multivariable analyses, HIV-EU children were more likely to fail treatment at 48 hours (risk ratio [RR]: 1.83, 95% confidence interval [CI]: 1.27-2.64, P = .001) and had higher in-hospital mortality (RR: 4.31, 95% CI: 1.44-12.87, P = .01) than HIV-unexposed children. Differences in outcomes by HIV exposure status were observed only among children under 6 months of age. HIV-EU children more frequently received treatment with a third-generation cephalosporin, but this did not reduce the risk of treatment failure in this group. CONCLUSIONS:HIV-EU children with pneumonia have higher rates of treatment failure and in-hospital mortality than HIV-unexposed children during the first 6 months of life. Treatment with a third-generation cephalosporins did not improve outcomes among HIV-EU children.
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