Increased Rates of Respiratory and Diarrheal Illnesses in HIV-Negative Persons Living With HIV-Infected Individuals in a Densely Populated Urban Slum in Kenya

• Authors: Joshua M. Wong, Centers for Disease Control and Prevention; Leonard Cosmas, Centers for Disease Control and Prevention; Dhillion Nyachieo, Kenya Medical Research Institute; John M. Williamson, Centers for Disease Control and Prevention; Beatrice Olack, Centers for Disease Control and Prevention; George Okoth, Centers for Disease Control and Prevention; Henry Njuguna, Centers for Disease Control and Prevention; Daniel R. Feikin, Centers for Disease Control and Prevention; Heather Burke, Centers for Disease Control and Prevention; Joel M. Montgomery, Centers for Disease Control and Prevention; Robert Breiman, Emory University
• Journal Title: Journal of Infectious Diseases
• Volume: Volume 212, Number 5
• Publisher: Oxford University Press (OUP): Policy B - Oxford Open Option C | 2015-02-25, Pages 745-753
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1093/infdis/jiv107
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; Microbiology; HIV; surveillance; home-based counseling and testing; household transmission; Africa; Kibera; nonspecific febrile illness; respiratory infection; pneumonia; influenzalike illness; ILI; acute lower respiratory infection; ALRI; diarrhea; incidence rates; urban slum; HUMAN-IMMUNODEFICIENCY-VIRUS; ANTIRETROVIRAL THERAPY; WESTERN KENYA; RISK-FACTORS; INFLUENZA; HEALTH; CRYPTOSPORIDIOSIS; HIV/AIDS; AFRICA; EPIDEMIOLOGY

Abstract

Background: Prolonged pathogen shedding and increased duration of illness associated with infections in immunosuppressed individuals put close human immunodeficiency virus (HIV)-negative contacts of HIV-infected persons at increased risk of exposure to infectious pathogens. Methods: We calculated incidence and longitudinal prevalence (number of days per year) of influenzalike illness (ILI), diarrhea, and nonspecific febrile illness during 2008 from a population-based surveillance program in the urban slum of Kibera (Kenya) that included 1830 HIV-negative household contacts of HIV-infected individuals and 13 677 individuals living in exclusively HIV-negative households. Results: For individuals ≥5 years old, incidence was significantly increased for ILI (risk ratio [RR], 1.47; P < .05) and diarrhea (RR, 1.41; P < .05) in HIV-negative household contacts of HIV-infected individuals compared with exclusively HIV-negative households. The risk of illness among HIV-negative persons was directly proportional to the number of HIV-infected persons living in the home for ILI (RR, 1.39; P < .05) and diarrhea (RR, 1.36; P < .01). We found no increased rates of illness in children <5 years old who lived with HIV-infected individuals. Conclusions: Living with HIV-infected individuals is associated with modestly increased rates of respiratory and diarrheal infections in HIV-negative individuals >5 years old. Targeted interventions are needed, including ensuring that HIV-infected persons are receiving appropriate care and treatment.