Investigating Mediators of the Poor Pneumonia Outcomes of Human Immunodeficiency Virus-Exposed but Uninfected Children.

Autor:	Kelly MS; Botswana-UPenn Partnership, Gaborone, Botswana.; Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina., Zheng J; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina., Boiditswe S; Botswana-UPenn Partnership, Gaborone, Botswana., Steenhoff AP; Botswana-UPenn Partnership, Gaborone, Botswana.; Global Health Center.; Division of Pediatric Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania.; University of Botswana School of Medicine, Gaborone, Botswana., Feemster KA; Global Health Center.; Division of Pediatric Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania., Arscott-Mills T; Botswana-UPenn Partnership, Gaborone, Botswana.; Global Health Center.; University of Botswana School of Medicine, Gaborone, Botswana., Seme B; Botswana-UPenn Partnership, Gaborone, Botswana., Ratshaa B; Botswana-UPenn Partnership, Gaborone, Botswana., Rulaganyang I; Botswana-UPenn Partnership, Gaborone, Botswana., Patel MZ; University of Botswana School of Medicine, Gaborone, Botswana., Mantzor S; Botswana-UPenn Partnership, Gaborone, Botswana.; Global Health Center., Shah SS; Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Ohio., Cunningham CK; Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina.
Jazyk:	angličtina
Zdroj:	Journal of the Pediatric Infectious Diseases Society [J Pediatric Infect Dis Soc] 2019 Mar 28; Vol. 8 (1), pp. 13-20.
DOI:	10.1093/jpids/pix092
Abstrakt:	Background: Human immunodeficiency virus-exposed but uninfected (HIV-EU) children have a higher mortality rate than the children of HIV-negative mothers (HIV-unexposed). Causal mediators of the poor health outcomes of HIV-EU children remain poorly defined. Methods: We conducted a hospital-based prospective cohort study of children aged 1 to 23 months with clinically defined pneumonia. The children were recruited at a referral hospital in Gaborone, Botswana, between April 2012 and June 2016. The primary outcome, treatment failure at 48 hours, was assessed by an investigator blinded to the children's HIV-exposure status. We examined associations between HIV exposure and pneumonia outcomes in HIV-uninfected children. We next determined whether the effect of HIV exposure on outcomes was mediated by low-birth-weight status, nonbreastfeeding, malnutrition, in utero exposure to combination antiretroviral therapy, or pneumonia severity. Results: A total of 352 HIV-uninfected children were included in these analyses, including 245 (70%) HIV-unexposed and 107 (30%) HIV-EU children. Their median age was 7.4 months, and 57% were male. Treatment failure occurred in 111 (32%) children, and 19 (5.4%) children died. HIV-EU children were more likely to fail treatment (risk ratio [RR], 1.57 [95% confidence interval (CI), 1.19-2.07]; P = .002) and had a higher in-hospital mortality rate (RR, 4.50 [95% CI, 1.86-10.85]; P = .001) than HIV-unexposed children. Nonbreastfeeding mediated 47% of the effect of HIV exposure on the risk of in-hospital death. Conclusions: HIV-EU children have worse pneumonia outcomes than HIV-unexposed children. Nonbreastfeeding mediates nearly half of the effect of HIV exposure on pneumonia mortality. Our findings provide additional evidence for a mortality benefit of breastfeeding by HIV-EU children. (© The Author(s) 2017. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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