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Understanding the contribution of common childhood illnesses and opportunistic infections to morbidity and mortality in children living with HIV in resource-limited settings

Modi, Surbhia; Chiu, Alexa,b; Ng’eno, Bernadettec; Kellerman, Scott E.d; Sugandhi, Nanditae; Muhe, Luluf; The Child Survival Working Group of the Interagency Task Team on the Prevention and Treatment of HIV Infection in Pregnant Women, Mothers and Child

doi: 10.1097/QAD.0000000000000080
Supplement Articles

Objective: Although antiretroviral treatment (ART) has reduced the incidence of HIV-related opportunistic infections among children living with HIV, access to ART remains limited for children, especially in resource-limited settings. This paper reviews current knowledge on the contribution of opportunistic infections and common childhood illnesses to morbidity and mortality in children living with HIV, highlights interventions known to improve the health of children, and identifies research gaps for further exploration.

Design and Methods: Literature review of peer-reviewed articles and abstracts combined with expert opinion and operational experience.

Results: Morbidity and mortality due to opportunistic infections has decreased in both developed and resource-limited countries. However, the burden of HIV-related infections remains high, especially in sub-Saharan Africa, where the majority of HIV-infected children live. Limitations in diagnostic capacity in resource-limited settings have resulted in a relative paucity of data on opportunistic infections in children. Additionally, the reliance on clinical diagnosis means that opportunistic infections are often confused with common childhood illnesseswhich also contribute to excess morbidity and mortality in these children. Although several preventive interventions have been shown to decrease opportunistic infection-related mortality, implementation of many of these interventions remains inconsistent.

Conclusions: In order to reduce opportunistic infection-related mortality, early ART must be expanded, training for front-line clinicians must be improved, and additional research is needed to improve screening and diagnostic algorithms.

aDivision of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Geogia, USA

bThe CDC Experience Applied Epidemiology Fellowship, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

cDivision of Global HIV/AIDS, Centers for Disease Control and Prevention, Nairobi, Kenya

dManagement Sciences for Health, Arlington, Virginia

eClinton Health Access Initiative, New York City, New York, USA

fWorld Health Organization, Geneva, Switzerland.

*Complete author list follows references.

Correspondence to Surbhi Modi, Medical Officer, Pediatric HIV Care and Treatment Team, Division of Global HIV/AIDS, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS-E04, Atlanta, GA 30333, USA. Tel: +1 404 639 8909; fax: +1 404 639 8114; e-mail:

© 2013 Lippincott Williams & Wilkins, Inc.