IMPACT OF HIV ON MORTALITY FROM ACUTE LOWER RESPIRATORY-TRACT INFECTION IN RURAL ZAMBIA

Aims - To establish the prevalence and clinical correlates of HIV amon g children with acute lower respiratory tract infection. Methods - Chi ldren 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) cri teria. Clinicians, who were unaware of the children's HIV status, pres cribed antibiotic and supportive treatment according to WHO guidelines . HIV status was established using the polymerase chain reaction (Ampl icor 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 ve ry 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%), o f whom four fulfilled the WHO clinical case definition for paediatric AIDS and five died. The group as a whole were malnourished, but the HI V 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 gro up but this was not significant (p = 0.079). Conclusions - An importan t minority of children with acute lower respiratory tract infection in rural Zambia will be infected with HIV. However, most HIV positive ch ildren presenting with respiratory infection will survive given simple antibiotic and supportive treatment.