Specific therapy may cut pneumonia mortality in HIV babies

By Lauretta Ihonor

The high mortality rate associated with acute severe pneumonia-related respiratory failure in infants exposed to or infected with HIV can be reduced to 30% if a treatment plan involving antibiotics, ventilation, and fluid restriction is used, researchers report.

The risk for death is greatest when cytomegalovirus (CMV) infection underlies the pneumonia; therefore, the use of CMV-specific treatment may help to minimize mortality risk among these infants, say Robin Green (Steve Biko Academic Hospital, Pretoria, South Africa) and colleagues.

They also highlight that "effective antenatal care with diagnosis and appropriate therapy of infected mothers can virtually eliminate the problems of HIV infection in young children."

Green and co-researchers recruited 63 infants aged 2-9 months who were admitted to hospital with HIV-related pneumonia and respiratory failure. All infants were either uninfected but exposed to HIV via an infected mother (n=10) or HIV-infected (n=53).

When the specific cause of the pneumonia was investigated via nonbronchoscopic bronchoalveolar lavage, Pneumocystis jiroveci was identified in 33% of the group and CMV in 55%. The CMV viral load was high enough to meet the definition of CMV disease (≥log 4) in 38% of the overall group.

The infants were treated with a trimethoprim-sulfamethoxazole co-formulation (20 mg/kg/day trimethoprim and 100 mg/kg/day sulfamethoxazole), oral steroids (1‑2 mg/kg/day), ampicillin, and amikacin antibiotics. Ganciclovir therapy was given to infants with a CMV load of at least log 4.

All infants had their total fluid intake restricted to 60-80 mL/kg/day and ventilator support was provided.

As reported in Pediatric Critical Care Medicine, 30% of the infants died from respiratory failure. Of these, 68% had a CMV load of at least log 4.

Among these CMV-infected infants with a viral load of at least log 4, death occurred at a mean period of 13 days.

Infants that survived were discharged after a mean period of 14 days.

Green and team conclude that more research into CMV prevention and treatment is needed if further decreases in the mortality rates associated with respiratory failure in HIV-infected or exposed infants are to be achieved.

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