title: Understanding the contribution of common childhood illnesses and opportunistic infections to morbidity and mortality in children living with HIV in resource-limited settings.
abstract: OBJECTIVE
  Although antiretroviral treatment (ART) has reduced the incidence of HIV-related opportunistic infections among children living with HIV, access to ART remains limited for children, especially in resource-limited settings. This paper reviews current knowledge on the contribution of opportunistic infections and common childhood illnesses to morbidity and mortality in children living with HIV, highlights interventions known to improve the health of children, and identifies research gaps for further exploration.
  
  
  METHODS
  Literature review of peer-reviewed articles and abstracts combined with expert opinion and operational experience.
  
  
  RESULTS
  Morbidity and mortality due to opportunistic infections has decreased in both developed and resource-limited countries. However, the burden of HIV-related infections remains high, especially in sub-Saharan Africa, where the majority of HIV-infected children live. Limitations in diagnostic capacity in resource-limited settings have resulted in a relative paucity of data on opportunistic infections in children. Additionally, the reliance on clinical diagnosis means that opportunistic infections are often confused with common childhood illnesseswhich also contribute to excess morbidity and mortality in these children. Although several preventive interventions have been shown to decrease opportunistic infection-related mortality, implementation of many of these interventions remains inconsistent.
  
  
  CONCLUSIONS
  In order to reduce opportunistic infection-related mortality, early ART must be expanded, training for front-line clinicians must be improved, and additional research is needed to improve screening and diagnostic algorithms.
authors.affiliation: aDivision of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Geogia, USA bThe CDC Experience Applied Epidemiology Fellowship, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA cDivision of Global HIV/AIDS, Centers for Disease Control and Prevention, Nairobi, Kenya dManagement Sciences for Health, Arlington, Virginia eClinton Health Access Initiative, New York City, New York, USA fWorld Health Organization, Geneva, Switzerland. *Complete author list follows references.
authors.forename: Surbhi
authors.initials: S
authors.lastname: Modi
authors.forename: Alex
authors.initials: A
authors.lastname: Chiu
authors.forename: Bernadette
authors.initials: B
authors.lastname: Ng'eno
authors.forename: Scott E
authors.initials: SE
authors.lastname: Kellerman
authors.forename: Nandita
authors.initials: N
authors.lastname: Sugandhi
authors.forename: Lulu
authors.initials: L
authors.lastname: Muhe
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D019380:Anti-HIV Agents / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control; D003141:Communicable Diseases / Q000175:diagnosis / Q000401:mortality*; D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D006295:Health Resources / Q000600:supply & distribution*; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D064890:Social Determinants of Health; D061665:Time-to-Treatment / Q000592:standards / Q000706:statistics & numerical data
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents