1. Investigating Mediators of the Poor Pneumonia Outcomes of Human Immunodeficiency Virus–Exposed but Uninfected Children
- Author
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Mohamed Z. Patel, Sefelani Boiditswe, Kristen A. Feemster, Ikanyeng Rulaganyang, Matthew S. Kelly, Jiayin Zheng, Bakgaki Ratshaa, Coleen K. Cunningham, Tonya Arscott-Mills, Boitshepe Seme, Samir S. Shah, Savarra Mantzor, and Andrew P. Steenhoff
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Respiratory Therapy ,Anti-HIV Agents ,Breastfeeding ,HIV Infections ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,030225 pediatrics ,medicine ,Humans ,030212 general & internal medicine ,Hospital Mortality ,Prospective Studies ,Treatment Failure ,Pregnancy Complications, Infectious ,Prospective cohort study ,Botswana ,business.industry ,Mortality rate ,Infant, Newborn ,virus diseases ,Infant ,General Medicine ,Original Articles ,Pneumonia ,Infant, Low Birth Weight ,Length of Stay ,medicine.disease ,Infant Nutrition Disorders ,Malnutrition ,Infectious Diseases ,Breast Feeding ,In utero ,Relative risk ,Prenatal Exposure Delayed Effects ,Pediatrics, Perinatology and Child Health ,Immunology ,Female ,business ,Breast feeding - Abstract
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.
- Published
- 2017