The impact of HIV infection on childhood pneumonia: comparison between developed and developing regions.

Respiratory disease is the commonest cause of morbidity and mortality in HIV-infected children. While the pattern of HIV-related pneumonia in African adults is well documented and is recognised as quite different from that which occurs among HIV-infected adults in high-income regions, less is known of the situation in children. Most children are infected by mother-to-child transmission and presentation of HIV-related pneumonia is often in infancy or early childhood, an age group in which confirmation of the cause of pneumonia is difficult. However, aetiological data are important. Poor response of the infant with severe pneumonia to standard antibiotic (such as chloramphenicol) or of the older child with chronic pneumonia to anti-tuberculosis treatment are two very common clinical dilemmas that many Malawian health workers would recognise. This review aims to present the available data relevant to Malawi, contrast with experience from the developed world and to describe common HIV-related pneumonias such as PCP and LIP. Unlike for adults, the pattern of HIV-related pneumonia in Malawian children may not be so different in cause from that described for children in developed countries prior to the use of PCP prophylaxis and anti-retroviral therapies. The most important contrast is the higher prevalence and poorer outcome.