title: Global, regional, and national estimates of pneumonia burden in HIV-infected children in 2010: a meta-analysis and modelling study.
abstract: BACKGROUND
  Globally, pneumonia is a leading cause of mortality and morbidity in children younger than 5 years. Underlying HIV infection is an important risk factor for pneumonia morbidity and mortality in children. There are, however, no global or country level estimates of pneumonia burden in HIV-infected children. We assessed the role of HIV in pneumonia incidence and mortality and estimated the number of pneumonia cases and deaths in HIV-infected children younger than 5 years in 133 high pneumonia-burden countries in 2010.
  
  
  METHODS
  We estimated the risk of hospital admission and case fatality rate caused by pneumonia in HIV-infected children compared with HIV-uninfected children from a systematic review of studies published in Medline, Embase, and Global Health between Jan 1, 1980, and Aug 31, 2013. We estimated nationwide pneumonia incidence and mortality with two different models that incorporated several risk factors for paediatric pneumonia hospital admission and mortality (including HIV infection). We then estimated the number of pneumonia episodes and deaths that occurred in HIV-infected children in 2010.
  
  
  RESULTS
  The odds ratio (OR) for hospital admission for all-cause pneumonia in HIV-infected children compared with HIV-uninfected children was 6·5 (95% CI 5·9-7·2). The risk of death was higher in children with pneumonia and HIV compared with those with pneumonia only (OR 5·9, 95% CI 2·7-12·7). In 2010, 1·4 million pneumonia episodes (uncertainty range [UR] 0·6 million to 3·3 million) and 88 000 pneumonia deaths (UR 47 400-153 000) occurred in HIV-infected children in low-income countries. Of these, 1·2 million pneumonia episodes (UR 0·5 million-2·7 million) and 85 400 deaths (UR 46 000-147 300) were directly attributable to HIV. 1·3 million (90%) pneumonia episodes and 82 400 (93%) pneumonia deaths in HIV-infected children aged younger than 5 years occurred in the WHO African region.
  
  
  CONCLUSIONS
  Globally, a small proportion of pneumonia episodes and pneumonia deaths occur in HIV-infected children. However, in the highest HIV-burden countries in sub-Saharan Africa (ie, Swaziland, Lesotho, and Zimbabwe) up to a fifth of all pneumonia cases and 60% of pneumonia deaths occur in HIV-infected children. In these countries, major reductions in child pneumonia mortality can be achieved only if the systemic challenges plaguing the health system (poor coverage of early infant testing for HIV, of antiretroviral drugs in pregnant women and young children, of co-trimoxazole prophylaxis, and of pneumococcal vaccination) can be overcome.
  
  
  BACKGROUND
  WHO.
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Evropi
authors.initials: E
authors.lastname: Theodoratou
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: McAllister
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Craig
authors.initials: C
authors.lastname: Reed
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Davies O
authors.initials: DO
authors.lastname: Adeloye
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Igor
authors.initials: I
authors.lastname: Rudan
authors.affiliation: Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland.
authors.forename: Lulu M
authors.initials: LM
authors.lastname: Muhe
authors.affiliation: Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Sandringham, South Africa; Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of Witwatersrand, Witwatersrand, South Africa; Department of Science and Technology, University of Witwatersrand, Witwatersrand, South Africa; Vaccine Preventable Diseases, National Research Foundation, University of Witwatersrand, Witwatersrand, South Africa.
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Harry
authors.initials: H
authors.lastname: Campbell
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK; Public Health Foundation of India, New Delhi, India. Electronic address: harish.nair@ed.ac.uk.
authors.forename: Harish
authors.initials: H
authors.lastname: Nair
mesh_terms: D002675:Child, Preschool; D005260:Female; D014943:Global Health; D015658:HIV Infections / Q000150:complications*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009026:Mortality; D011014:Pneumonia / Q000453:epidemiology* / Q000401:mortality; D016019:Survival Analysis