Increased Rates of Respiratory and Diarrheal Illnesses in HIV-Negative Persons Living With HIV-Infected Individuals in a Densely Populated Urban Slum in Kenya.
BACKGROUND
Prolonged pathogen shedding and increased duration of illness associated with infections in immunosuppressed individuals put close human immunodeficiency virus (HIV)-negative contacts of HIV-infected persons at increased risk of exposure to infectious pathogens.


METHODS
We calculated incidence and longitudinal prevalence (number of days per year) of influenzalike illness (ILI), diarrhea, and nonspecific febrile illness during 2008 from a population-based surveillance program in the urban slum of Kibera (Kenya) that included 1830 HIV-negative household contacts of HIV-infected individuals and 13 677 individuals living in exclusively HIV-negative households.


RESULTS
For individuals ≥5 years old, incidence was significantly increased for ILI (risk ratio [RR], 1.47; P < .05) and diarrhea (RR, 1.41; P < .05) in HIV-negative household contacts of HIV-infected individuals compared with exclusively HIV-negative households. The risk of illness among HIV-negative persons was directly proportional to the number of HIV-infected persons living in the home for ILI (RR, 1.39; P < .05) and diarrhea (RR, 1.36; P < .01). We found no increased rates of illness in children <5 years old who lived with HIV-infected individuals.


CONCLUSIONS
Living with HIV-infected individuals is associated with modestly increased rates of respiratory and diarrheal infections in HIV-negative individuals >5 years old. Targeted interventions are needed, including ensuring that HIV-infected persons are receiving appropriate care and treatment.
Centers for Disease Control and Prevention.
Joshua M
JM
Wong
Centers for Disease Control and Prevention.
Leonard
L
Cosmas
Kenya Medical Research Institute, Nairobi.
Dhillon
D
Nyachieo
Centers for Disease Control and Prevention.
John M
JM
Williamson
Kenya Medical Research Institute, Nairobi.
Beatrice
B
Olack
Kenya Medical Research Institute, Nairobi.
George
G
Okoth
Centers for Disease Control and Prevention.
Henry
H
Njuguna
Centers for Disease Control and Prevention.
Daniel R
DR
Feikin
Centers for Disease Control and Prevention.
Heather
H
Burke
Centers for Disease Control and Prevention.
Joel M
JM
Montgomery
Emory Global Health Institute, Emory University, Atlanta, Georgia.
Robert F
RF
Breiman
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology*; D004781:Environmental Exposure; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections; D006801:Humans; D015994:Incidence; D007630:Kenya; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D015995:Prevalence; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D018570:Risk Assessment; D014505:Urban Population; D055815:Young Adult
ALRI; Africa; HIV; ILI; Kibera; acute lower respiratory infection; diarrhea; home-based counseling and testing; household transmission; incidence rates; influenzalike illness; nonspecific febrile illness; pneumonia; respiratory infection; surveillance; urban slum