Understanding the Contribution of Common Childhood Illnesses and Opportunistic Infections to Morbidity and Mortality in Children Living with HIV in Resource-Limited Settings

Journal Article
  • Surbhia Modi
  • Alexa Chiu
  • Bernadette Ng’eno
  • Scott E. Kellerman
  • Nandita Sugandhi
  • Lulu Muhe
Nov. 2013; 27 (supplement 2): S159-167. DOI: 10.1097/QAD.0000000000000080.

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. 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 illnesses, which 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. 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.