title: High Viremia and Wasting Before Antiretroviral Therapy Are Associated With Pneumonia in Early-Treated HIV-Infected Kenyan Infants.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV)-infected children are particularly susceptible to acute respiratory infections (ARIs). We determined incidence and cofactors for ARIs in HIV-infected infants receiving antiretroviral therapy (ART).
  
  
  METHODS
  Human immunodeficiency virus-infected infants initiated ART at ≤12 months of age and were observed monthly for 2 years in Nairobi. Acute respiratory infection rates and cofactors were determined using Andersen-Gill models, allowing for multiple events per infant.
  
  
  RESULTS
  Among 111 HIV-infected infants, median age at ART initiation was 4.5 months. Pre-ART median CD4% was 19%, and 29% had wasting. During 24-months follow-up while on ART, upper respiratory infection (URI) and pneumonia rates were 122.6 and 34.7 per 100 person-years (py), respectively. Infants with higher pre-ART viral load (VL) (plasma HIV ribonucleic acid [RNA] ≥7 log10 copies/mL) had 4.12-fold increased risk of pneumonia (95% confidence interval [CI], 2.17-7.80), and infants with wasting (weight-for-height z-score < -2) had 2.87-fold increased risk (95% CI, 1.56-5.28). Infants with both high pre-ART VL and wasting had a higher pneumonia rate (166.8 per 100 py) than those with only 1 of these risk factors (44.4 per 100 py) or neither (17.0 per 100 py). Infants with exposure to wood fuel had significantly higher risk of URI (hazard ratio [HR] = 1.82; 95% CI, 1.44-2.28) and pneumonia (HR = 3.31; 95% CI, 1.76-6.21).
  
  
  CONCLUSIONS
  In early ART-treated HIV-infected infants, higher HIV RNA and wasting before ART were independent risk factors for pneumonia. Wood fuel use was associated with URI and pneumonia. Additional data on air pollution and respiratory outcomes in HIV-infected children may help optimize interventions to improve their lung health.
authors.affiliation: Department of Global Health, University of Washington, Seattle.
authors.forename: Geetha
authors.initials: G
authors.lastname: Sridharan
authors.affiliation: Department of Paediatrics and Child Health, University of Nairobi, Kenya.
authors.forename: Dalton
authors.initials: D
authors.lastname: Wamalwa
authors.affiliation: Department of Global Health, University of Washington, Seattle.
authors.forename: Grace
authors.initials: G
authors.lastname: John-Stewart
authors.affiliation: Department of Global Health, University of Washington, Seattle.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Tapia
authors.affiliation: Department of Paediatrics and Child Health, University of Nairobi, Kenya.
authors.forename: Agnes
authors.initials: A
authors.lastname: Langat
authors.affiliation: Department of Paediatrics and Child Health, University of Nairobi, Kenya.
authors.forename: Helen
authors.initials: H
authors.lastname: Moraa Okinyi
authors.affiliation: Department of Paediatrics and Child Health, University of Nairobi, Kenya.
authors.forename: Judith
authors.initials: J
authors.lastname: Adhiambo
authors.affiliation: Department of Paediatrics and Child Health, University of Nairobi, Kenya.
authors.forename: Daisy
authors.initials: D
authors.lastname: Chebet
authors.affiliation: Department of Paediatrics and Child Health, University of Nairobi, Kenya.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Maleche-Obimbo
authors.affiliation: Department of Pediatrics, University of Washington, Seattle.|Department of Environmental and Occupational Health Sciences, University of Washington, Seattle.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Karr
authors.affiliation: Department of Global Health, University of Washington, Seattle.
authors.forename: Sarah
authors.initials: S
authors.lastname: Benki-Nugent
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D019247:HIV Wasting Syndrome / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007223:Infant; D007630:Kenya; D008297:Male; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D014766:Viremia / Q000453:epidemiology* / Q000209:etiology
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; acute respiratory infections; home air pollution; infants; pneumonia