HIV This Week

Moss WJ, Fisher C, Scott S, Monze M, Ryon JJ, Quinn TC, Griffin DE, Cutts FT. W. HIV type 1 infection is a risk factor for mortality in hospitalized Zambian children with measles. 15: Clin Infect Dis. 2008 Feb 15;46(4):523-7.

Measles remains a significant cause of vaccine-preventable mortality in sub-Saharan Africa, yet few studies have investigated risk factors for measles mortality in regions of high human immunodeficiency virus type 1 (HIV-1) prevalence. Between January 1998 and July 2003, children with clinically diagnosed measles who were hospitalized at the University Teaching Hospital in Lusaka, Zambia, were enrolled in an observational study. Demographic and clinical information was recorded at enrollment and at discharge or death. Measles was confirmed by detection of antimeasles virus immunoglobulin M antibodies, and HIV-1 infection was confirmed by detection of HIV-1 RNA. Of 1474 enrolled children, 1227 (83%) had confirmed measles and known HIV-1 infection status. Almost one-third of the HIV-1-infected children with measles were <9 months of age, the age of routine measles vaccination, compared with one-fourth of the uninfected children (P = .07). Death occurred during hospitalization in 23 (12.2%) of the HIV-1-infected children and 45 (4.3%) of the HIV-1-uninfected children (p < .001) with measles. After adjusting for age, sex, and measles vaccination status, HIV-1 infection (odds ratio, 2.5; 95% confidence interval, 1.4-4.6), < or =8 years of maternal education (odds ratio, 2.4; 95% confidence interval, 1.2-4.8), and the presence of an esquamating rash (odds ratio, 2.2, 95% confidence interval, 1.3-3.6) were significant predictors of mortality due to measles. In a region of high HIV-1 prevalence, coinfection with HIV-1 more than doubled the odds of death in hospitalized children with measles.  Increased mortality among HIV-1-infected children is further evidence that greater efforts are necessary to reduce transmission of the measles virus in regions of high HIV-1 prevalence.

Editors’ note: Infants born to mothers with HIV infection often have lower levels of the maternal antibodies against measles that would otherwise normally provide them protection as infants. Either fewer passively acquired antibodies are transferred across the placenta or they are lost prematurely compared with other infants. Consideration should be given to early measles immunization for all infants born to women with HIV infection. Intensified community measles vaccine campaigns will help reduce the amount of circulating measles virus thereby protecting them further.