HIV-related Lung Disease

HIV infection is a major cause of lung disease in children in HIV-endemic countries. Most of the HIV-related morbidity and mortality in HIV-infected children is due to acute and chronic lung disease, and HIV-exposed but uninfected infants are also at increased risk of pneumonia. The risk of bacterial pneumonia and tuberculosis is far higher than for HIV-uninfected children. HIV-infected infants are particularly susceptible to opportunistic pathogens such as Pneumocystis and cytomegalovirus; co-infections with other pathogens are common; and pneumonia is often fatal.

HIV poses a major challenge to efforts to reduce the high pneumonia-related mortality in HIV-endemic regions of sub-Saharan Africa. There are a number of common causes of chronic lung disease in HIV-infected children, such as lymphoid interstitial pneumonitis and bronchiectasis, that can be difficult to differentiate from TB. Available interventions that have huge potential to reduce the burden of HIV-related lung disease include reduction of antenatal HIV prevalence, prevention of mother-to-child transmission of HIV, cotrimoxazole preventive therapy for HIV-exposed infants and HIV-infected children, IPT and antiretroviral therapy.

The management of HIV-related lung disease in children is a part of the Child Lung Health training. The Union's CLH programme has shown that pneumonia-related mortality in children can be reduced even in a high HIV-endemic setting, such as Malawi. The Union has worked with the Child and Adolescent Health department of WHO to produce guidelines on the case management of pneumonia in HIV-infected children or in children presenting in HIV-endemic settings. The Union also facilitated and participated in the development of the guidance for management of TB in HIV-infected children, jointly with WHO.