Table 1.
Characteristics of studies analysed
| Study period | Age range | Setting | Design | HIV case definition | Pneumonia case definition | Category | Odds ratio (95% CI) for pneumonia morbidity | Odds ratio for pneumonia mortality*(95% CI) | |
|---|---|---|---|---|---|---|---|---|---|
| USA26 | 1990–94 | 0–12 months | Urban | Hospital-based prospective cohort | HIV status confirmed with PCR serum HIV RNA testing (Amplicor HIV-1 monitor test), CDC classification | Clinical and radiological definition of pneumonia | Clinical pneumonia | 22·1 (6·3–77·7) | .. |
| Nairobi, Kenya27 | 1992–98 | 0–24 months | Mixed | Prospective birth cohort study | HIV DNA PCR testing, WHO classification | Clinical and radiological definition of pneumonia | Clinical pneumonia | 1·3 (0·5–3·5) | .. |
| Harare, Zimbabwe28 | 1997–2001 | 0–11 months | Mixed | Hospital-based prospective cohort enrolled in trial | ELISA for samples collected at ≥18 months, PCR for <18 months, WHO classification | Physician diagnosed acute lower respiratory infection | Clinical pneumonia | 3·0 (1·9–4·8) | .. |
| Soweto, Johannesburg, South Africa29 | 1997–98 | 2–24 months | Urban | Hospital-based prospective cohort | ELISA, based on CDC classification | Pneumonia based on WHO criteria: tachypnoea (>50 breaths per min in children aged 2–12 months and >40 breaths per min in older children), chest wall indrawing, arterial SpO2 <90% on room air | Severe pneumonia | .. | 5·6 (3·1–10·4) |
| Soweto, Johannesburg, South Africa15 | 1997–2001 | 2–59 months | Urban | Hospital-based cohort | ELISA, HIV RNA PCR, CDC criteria for HIV | Admitted to hospital with a study physician diagnosis of pneumonia or bronchiolitis irrespective of clinical or radiographic features (clinical pneumonia); cough with lower chest wall indrawing or feeding difficulties, convulsions, central cyanosis, or encephalopathy, or both (very severe pneumonia); presence of endpoint consolidation (dense fluffy opacity that occupies a portion or whole of the lung that may or may not contain air-bronchograms) or pleural effusion in the lateral pleural space that was spatially associated with the infiltrate on a chest radiograph and confirmed by at least two independent readers or one reader and arbiter with standard WHO training (WHO primary endpoint pneumonia) | Clinical pneumonia; very severe pneumonia; WHO primary endpoint pneumonia | For clinical pneumonia 6·5 (5·9–7·3); for very severe pneumonia 7·9 (7·1–8·9); for WHO primary endpoint pneumonia 14·2 (12·8–15·9) | For clinical pneumonia 14·2 (9·1–22·3) |
| Cape Town, South Africa30 | 1998 | 0–59 months | Rural | Hospital-based prospective study | ELISA, HIV DNA PCR testing, WHO criteria | WHO criteria (tachypnoea or chest wall indrawing) | Clinical pneumonia | .. | 2·5 (1·2–5·5) |
| Manhica, Mozambique31 | 2004–06 | 0–23 months | Rural | Demographic surveillance, prospective study | HIV infection defined according to WHO criteria, by ELISA and HIV RNA PCR | Physician-diagnosed pneumonia with chest wall indrawing (severe pneumonia); presence of endpoint consolidation (dense fluffy opacity that occupies a portion or whole of the lung that may or may not contain air-bronchograms) or pleural effusion in the lateral pleural space that was spatially associated with the infiltrate on a chest radiograph and confirmed by at least two independent readers or one reader and arbiter with standard WHO training (WHO primary endpoint pneumonia) | Severe pneumonia; WHO primary endpoint pneumonia | For severe pneumonia 14·9 (10·9–20·3); for WHO primary endpoint pneumonia 19·7 (12·3–31·4) | For severe pneumonia 12·9 (3·7–45·4) |
| Kampala, Uganda32 | 2005–06 | 2–59 months | Mixed | Hospital-based prospective cohort | HIV defined according to WHO criteria (DNA PCR for <18 months, rapid test for >18 months) | Cough or difficult breathing, tachypnoea and chest wall indrawing | Severe pneumonia | .. | 4·1 (1·7–10·1) |
| Kwazulu-Natal and Limpopo provinces, South Africa33 | 2006–07 | 2–59 months | Rural | Hospital-based cohort | HIV status confirmed with PCR RNA testing, WHO classification | Tachypnoea (>50 breaths per min in children aged 2–11 months, >40 breaths per min in older children; pneumonia); cough with chest indrawing with or without fast breathing (severe pneumonia) | Clinical pneumonia; severe pneumonia | For clinical pneumonia 1·8 (1·0–3·2); for severe pneumonia 7·1 (3·4–14·8) |
*
Ratio of case fatality rate for pneumonia in HIV-infected compared with HIV-uninfected. CDC=US Centres for Disease Control and Prevention. SpO2=peripheral capillary oxygen saturation.