Respiratory tract infection in HIV-1-infected adults in Nairobi, Kenya - Evaluation of risk factors and the World Health Organization treatment algorithm

To evaluate the WHO (World Health Organization) algorithm for management of respiratory tract infection (RTI) in HIV-1-infected adults and determine r isk factors associated with RTI, we enrolled a cohort of 380 HIV-1-seroposi tive adults prospectively followed for incident RTI at an outpatient clinic in Nairobi, Kenya. RTI was diagnosed when patients presented with history of worsening or persistent cough. Patients were treated with ampicillin, or antituberculosis therapy when clinically indicated, as first-line therapy and with trimethoprim/sulfamethoxazole as second-line therapy. Five hundred ninety-seven episodes of RTI were diagnosed: 177 of pneumonia and 420 of b ronchitis. The WHO RTI algorithm was used for 401 (95%) episodes of bronchi tis and 151 (85%) episodes of pneumonia (p < .001). Three percent of bronch itis cases versus 32% of pneumonia cases failed to respond to first- or sec ond-line treatment (p < .0001). Being widowed (adjusted odds ratio [OR] = 2 .1, 95% confidence interval (CI: 1.0-4.4), less than 8 years of education ( adjusted OR = 2.5. CL 1.5-4.1), and CD4 count < 200 cells/mul (adjusted OR = 2.4, Cl: 1.4-3.9) were risk factors for pneumonia. A high percentage of p atients (32%) with pneumonia required a change in treatment from that recom mended by the WHO guidelines. Randomized trials should be performed to dete rmine more appropriate treatment strategies in HIV-1-infected individuals.