Micheloud D. Pediatr Infect Dis J.
2012;doi:10.1097/INF.0b013e3182501cd4.
The rate of pneumonia in children with HIV decreased due
to highly active antiretroviral therapy, according to the results of a recent
study.
Dariela Micheloud, MD, PhD,and colleagues of the
Hospital General Universitario Gregorio Marañón in Madrid, Spain,
performed a retrospective study on 168 children aged younger than 17 years with
HIV who were hospitalized from 1997 to 2008.
Of 180 pneumonia diagnoses (some of the children were
re-diagnosed), 137 had non-AIDS–defining pneumonia (non-ADP) and 43 had
AIDS-defining pneumonia (ADP).
The researchers tracked disease patterns among the
children and reported that the rate of pneumonia was four times higher in
children with HIV than in the general population.
The overall rate of pneumonia (events per 1,000
HIV-infected children/year) in the whole follow-up period was 13.77. The
non-ADP rate was 10.48 and ADP rate was 3.28, the researchers wrote.
Micheloud and colleagues attributed the reduced rate of
ADP in children with HIV to increased use of HAART.
“The rate of pneumonia decreased among HIV-infected
children in the HAART era, although the pneumonia rate still remains higher
than in the general population,” the researchers said. “Non-ADP
remains a significant health problem for HIV-infected children in Spain.”
The researchers noted some limitations to the data,
notably lack of access to patient clinical data, data set anonymity and the
lack of national coverage data of HIV-infected children in Spain.
Disclosure: The researchers report no relevant
financial disclosures.
This manuscript highlights two important issues: 1) the impact of
antiretroviral therapy to reduce infectious complications in HIV-1-infected
children receiving treatment; and 2) Children with HIV-1-infection remain more
vulnerable to infections than healthy uninfected children regardless of
antiretroviral therapy. The authors acknowledge a number of limitations
including an inability to assess compliance with antiretroviral regimens. The
persistence in an increased risk for pneumonia in the treated HIV-1-infected
children could be influenced by compliance and preservation of immune function.
In addition, they do not provide information concerning whether the children
(infected with HIV-1 or uninfected) received vaccines to prevent pneumococcal
or Haemophilus influenzae type b infections. This would be relevant if these
bacteria were more commonly noted in children with HIV-1 infection. The
manuscript does not provide a description of the specific pathogens (viruses,
bacteria, fungi, etc.) causing the AIDS-defining pneumonias nor the
non-AIDS-defining pneumonias. The manuscript does not provide duration of
hospitalization, intensive care admissions or any other measure of severity.
The particular pathogens and severity of disease may be relevant to
understanding the true increased burden of disease to antiretroviral-treated
children with HIV-1 infection. Antiretroviral therapy has significantly
improved the survival and quality of life of children with HIV-1 infection.
This current manuscript documents a reduction in pneumonia hospitalizations
during the time period when highly active antiretroviral therapy became
available. It also notes that the rates of pneumonias continued to decline as
one would anticipate greater utilization of antiretroviral therapy with
opportunities for immune recovery. However, the persistent increase in the rate
of pneumonias in the children with HIV-1 infection in this time period of
antiretroviral therapy highlights the need to ensure access to HIV treatment,
high rates of compliance with antiretroviral therapy and use of other important
preventive interventions, such as appropriate immunizations and
chemoprophylaxis for opportunistic infections if immune compromise exists.
- Michael T. Brady, MD
Chair of the department
of pediatrics, The Ohio State University/Nationwide Children's Hospital,
Columbus, Ohio
Chair of the AAP's Red Book Committee