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Abstract
Pneumonia remains the most common cause of hospitalization and the most important cause of death in young children. In high human immunodeficiency virus (HIV)-burden settings, HIV-infected children carry a high burden of lower respiratory tract infection from common respiratory viruses, bacteria and Mycobacterium tuberculosis. In addition, Pneumocystis jirovecii and cytomegalovirus are important opportunistic pathogens. As the vertical transmission risk of HIV decreases and access to antiretroviral therapy increases, the epidemiology of these infections is changing, but HIV-infected infants and children still carry a disproportionate burden of these infections. There is also increasing recognition of the impact of in utero exposure to HIV on the general health of exposed but uninfected infants. The reasons for this increased risk are not limited to socioeconomic status or adverse environmental conditions—there is emerging evidence that these HIV-exposed but uninfected infants may have particular immune deficits that could increase their vulnerability to respiratory pathogens. We discuss the impact of tuberculosis and other lower respiratory tract infections on the health of HIV-infected infants and children.
Highlights
To prevent vertical transmission of human immunodeficiency virus (HIV) from mother to child and to improve long-term outcomes for HIV-infected pregnant women, the current standard of care is to initiate lifelong suppressive antiretroviral therapy (ART) [1]
Lower respiratory tract infections (LRTI) in HIV-infected children are from common childhood respiratory pathogens, as well as opportunistic pathogens, such as Pneumocystis jirovecii, cytomegalovirus (CMV) and Mycobacterium tuberculosis [7,8,9,10,11]
Boosted protease inhibitor (PI): increase rifabutin levels and rifabutin dose reduction is needed Nonnucleoside reverse transcriptase inhibitors (NNRTI): Efavirence reduces the concentration of rifabutin, increasing the rifabutin dose is recommended in adults Nevirapine dose adjustment is not needed for rifabutin
Summary
To prevent vertical transmission of human immunodeficiency virus (HIV) from mother to child and to improve long-term outcomes for HIV-infected pregnant women, the current standard of care is to initiate lifelong suppressive antiretroviral therapy (ART) [1]. A randomizedcontrolled trial to assess the effect of universal isoniazid preventive therapy (IPT) in HIV-infected children found a TB disease rate of 121 per 1000 patient-years in children who had early ART access [16]. Young age is poorly studied as a risk factor in HIV-infected children in resource-limited settings, but as many as 33% of infants starting ART at a median age of 8 months are already receiving anti-TB therapy [28].
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