Impact of HIV on mortality from acute lower respiratory tract infection in rural Zambia

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Abstract
AIMS To establish the prevalence and clinical correlates of HIV among children with acute lower respiratory tract infection. METHODS Children admitted to a rural Zambian hospital were studied over an eight month period. The diagnosis of acute lower respiratory tract infection was made clinically, according to World Health Organisation (WHO) criteria. Clinicians, who were unaware of the children’s HIV status, prescribed antibiotic and supportive treatment according to WHO guidelines. HIV status was established using the polymerase chain reaction (Amplicor HIV1, Roche) applied to dried blood spots. RESULTS Acute lower respiratory tract infection was diagnosed in 132 children (median age 8 months, range 1 month to 4 years). The WHO criteria for severe or very severe pneumonia were met by 96/132 patients (73%) and 21 patients (16%) died. HIV dried blood spot PCR was positive in 14 cases (11%), of whom four fulfilled the WHO clinical case definition for paediatric AIDS and five died. The group as a whole were malnourished, but the HIV positive children were more severely malnourished (mean z score for weight = −3.01) than the HIV negative children (mean z score = −1.73, p < 0.001). The relative risk of death was 2.6 in the HIV positive group but this was not significant (p = 0.079). CONCLUSIONS An important minority of children with acute lower respiratory tract infection in rural Zambia will be infected with HIV. However, most HIV positive children presenting with respiratory infection will survive given simple antibiotic and supportive treatment.