Theodoratou Evropi, McAllister David A, Reed Craig, Adeloye Davies O, Rudan Igor, Muhe Lulu M, Madhi Shabir A, Campbell Harry, Nair Harish
Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland.
Lancet Infect Dis. 2014 Dec;14(12):1250-8. doi: 10.1016/S1473-3099(14)70990-9. Epub 2014 Nov 12.
Globally, pneumonia is a leading cause of mortality and morbidity in children younger than 5 years. Underlying HIV infection is an important risk factor for pneumonia morbidity and mortality in children. There are, however, no global or country level estimates of pneumonia burden in HIV-infected children. We assessed the role of HIV in pneumonia incidence and mortality and estimated the number of pneumonia cases and deaths in HIV-infected children younger than 5 years in 133 high pneumonia-burden countries in 2010.
We estimated the risk of hospital admission and case fatality rate caused by pneumonia in HIV-infected children compared with HIV-uninfected children from a systematic review of studies published in Medline, Embase, and Global Health between Jan 1, 1980, and Aug 31, 2013. We estimated nationwide pneumonia incidence and mortality with two different models that incorporated several risk factors for paediatric pneumonia hospital admission and mortality (including HIV infection). We then estimated the number of pneumonia episodes and deaths that occurred in HIV-infected children in 2010.
The odds ratio (OR) for hospital admission for all-cause pneumonia in HIV-infected children compared with HIV-uninfected children was 6·5 (95% CI 5·9-7·2). The risk of death was higher in children with pneumonia and HIV compared with those with pneumonia only (OR 5·9, 95% CI 2·7-12·7). In 2010, 1·4 million pneumonia episodes (uncertainty range [UR] 0·6 million to 3·3 million) and 88 000 pneumonia deaths (UR 47 400-153 000) occurred in HIV-infected children in low-income countries. Of these, 1·2 million pneumonia episodes (UR 0·5 million-2·7 million) and 85 400 deaths (UR 46 000-147 300) were directly attributable to HIV. 1·3 million (90%) pneumonia episodes and 82 400 (93%) pneumonia deaths in HIV-infected children aged younger than 5 years occurred in the WHO African region.
Globally, a small proportion of pneumonia episodes and pneumonia deaths occur in HIV-infected children. However, in the highest HIV-burden countries in sub-Saharan Africa (ie, Swaziland, Lesotho, and Zimbabwe) up to a fifth of all pneumonia cases and 60% of pneumonia deaths occur in HIV-infected children. In these countries, major reductions in child pneumonia mortality can be achieved only if the systemic challenges plaguing the health system (poor coverage of early infant testing for HIV, of antiretroviral drugs in pregnant women and young children, of co-trimoxazole prophylaxis, and of pneumococcal vaccination) can be overcome.
WHO.
在全球范围内，肺炎是5岁以下儿童死亡和发病的主要原因。潜在的艾滋病毒感染是儿童肺炎发病和死亡的一个重要危险因素。然而，目前尚无关于艾滋病毒感染儿童肺炎负担的全球或国家层面的估计。我们评估了艾滋病毒在肺炎发病率和死亡率中的作用，并估计了2010年133个肺炎高负担国家中5岁以下艾滋病毒感染儿童的肺炎病例数和死亡数。
通过对1980年1月1日至2013年8月31日期间发表在《医学索引》（Medline）、《荷兰医学文摘数据库》（Embase）和《全球健康》上的研究进行系统评价，我们估计了与未感染艾滋病毒的儿童相比，感染艾滋病毒的儿童因肺炎住院的风险和病死率。我们使用两种不同的模型估计全国肺炎发病率和死亡率，这两种模型纳入了儿童肺炎住院和死亡的多个危险因素（包括艾滋病毒感染）。然后，我们估计了2010年艾滋病毒感染儿童中发生的肺炎发作次数和死亡数。
与未感染艾滋病毒的儿童相比，感染艾滋病毒的儿童因各种原因肺炎住院的比值比（OR）为6.5（95%置信区间[CI]5.9 - 7.2）。与仅患有肺炎的儿童相比，患有肺炎和艾滋病毒的儿童死亡风险更高（OR 5.9，95% CI 2.7 - 12.7）。2010年，低收入国家的艾滋病毒感染儿童中发生了140万次肺炎发作（不确定范围[UR]60万至330万）和8.8万例肺炎死亡（UR 4.74万 - 15.3万）。其中，120万次肺炎发作（UR 50万 - 270万）和8.54万例死亡（UR 4.6万 - 14.73万）直接归因于艾滋病毒。5岁以下艾滋病毒感染儿童中130万次（90%）肺炎发作和8.24万例（93%）肺炎死亡发生在世卫组织非洲区域。
在全球范围内，一小部分肺炎发作和肺炎死亡发生在艾滋病毒感染儿童中。然而，在撒哈拉以南非洲艾滋病毒负担最高的国家（即斯威士兰、莱索托和津巴布韦），所有肺炎病例中高达五分之一以及60%的肺炎死亡发生在艾滋病毒感染儿童中。在这些国家，只有克服困扰卫生系统的系统性挑战（艾滋病毒早期婴儿检测、孕妇和幼儿抗逆转录病毒药物、复方新诺明预防用药以及肺炎球菌疫苗接种的覆盖率低），才能大幅降低儿童肺炎死亡率。
世界卫生组织。
