HIV drives children’s pneumonia in sub-Saharan Africa

Abstract

Nokhwezi Hobovi knows about the devastation of pneumonia after losing her first two babies to the disease. 27-year-old mother from Cape Town saw her first child die of pneumonia at four months of age. Her second child started coughing at two months and was diagnosed with pneumonia. She was hospitalized, became ill at three months and did not respond to antibiotics. Hohoyi, an AIDS activist, said: The doctor asked me if he could test her for HIV and I agreed. She tested positive. She developed pneumonia and had to be transferred to intensive care. Her health deteriorated and she also passed away. Last November Hoboyi, who has since been put on antiretroviral therapy cried tears of joy when her third baby Qhayiya, tested ncgative for HIV. Pneumonia is a common cause of illness and death among children aged less than five years and those with HIV--particularly infants--are especially vulnerable. Children with HIV are at higher risk of contracting pneumonia, becoming ill from it and dying than children who are HIV negative. And they, fare worse on treatment, which is further complicated by the need for a wide range of antibiotics to counter numerous opportunistic infections. makes treatment more expensive and increases the risk of bacterial resistance to the drugs prescribed. More lives are saved, however, by early identification of children with the potentially lethal combination and by putting them on appropriate preventive treatment, rather than treating HIV-positive children once they have contracted pneumonia. Dr Andrew Mbewe, regional adviser for Child and Adolescent Health and Development at the Regional Office for Africa of the World Health Organization (WHO), says that in sub-Saharan Africa four diseases or conditions are responsible for more than 70% of deaths among children less than five years of age: diarrhoea, malaria, malnutrition and pneumonia. This [toll] is worse where HIV is prevalent. [ILLUSTRATION OMITTED] One sign of HIV that health workers following WHO's Integrated Management of Childhood Illness guidelines are advised to look out for is persistent and recurrent pneumonia. With the rise of HIV in South Africa, pneumonia cases among children have soared. children's wards in South Africa's biggest hospital, the Chris Hani Baragwanath in Soweto, are full of children with this potentially lethal combination. The incidence of hospitalization for pneumonia has increased exponentially in tandem with the increase in the HIV epidemic over the past two decades, says Professor Shabir Madhi, co-director of the Respiratory and Meningeal Pathogens Research Unit of Witswatersrand University, which is based at Baragwanath Hospital. Currently 50% of children who are hospitalized for pneumonia in South Africa are HIV infected, even though they make up less than 5% of the childhood population, Madhi says, adding: children have an increased risk of being colonized with pneumococcus and a 40-fold greater risk of developing several invasive pneumococcal diseases. case fatality rate for HIV-infected children with pneumonia in hospital is about 7% compared to about 1.5% for children who are not infected, he says. Children with HIV generally get worse, more protracted and recurrent pneumonia than those who are HIV negative, according to Dr Tammy Meyers, director of the Harriet Shezi Children's Clinic at Baragwanath Hospital. Dr Prakash Jeena, head of Paediatric Pulmonology at the Nelson Mandela School of Medicine, has also seen a marked increase in the incidence of pneumonia among children. …