Higher Exposure to Household Air Pollution Is Associated With Acute Lower Respiratory Illness in Human Immunodeficiency Virus-Infected Kenyan Infants

Abstract

Background. Household air pollution (HAP) impacts early childhood health and mortality; however, the impact of HAP on early childhood respiratory illness in human immunodeficiency virus (HIV)-infected children has not been defined. Methods. Human immunodeficiency virus-infected children initiated antiretroviral therapy at <2.5 micrometers in diameter (PM2.5) was conducted. Exposure levels were summarized as the mean and maximum PM2.5 levels over the 24-hour monitoring period. Kaplan-Meier survival methods and Cox proportional hazard models with Anderson Gill methods were used to evaluate the relationship between high exposure and time to first pneumonia, and rates of pneumonia, allowing for multiple events, respectively. Results. Among 50 enrolled HIV-infected children, median age was 6.7 years (interquartile range [IQR], 613-7.3) and 56% were male. Among 35 households with 24- hour sampling, mean personal PM2.5 exposure was 22.7 mug/m3 (IQR, 12.2-51.9), and maximum was 612 mug/m3 (IQR, 286-1093). Approximately half (42%) had 24-hour mean PM2.5 exposure above the World Health Organization (WHO) safe air quality threshold (PM2.5 >=25 mug/m3), and 27% had maximums >=1000 mug/m3. Human immunodeficiency virus-infected children with a maximum PM2.5 exposure >=1000 mug/m3 had a 4-fold increased risk of pneumonia (hazard ratio, 4.2; 95% confidence interval, 1.3-14.1; P = 0.02). Conclusion. Many HIV-infected children had PM2.5 exposures that surpass the safety standards set by the WHO. Higher exposure to PM2.5 was associated with higher infant pneumonia incidence rates. Human immunodeficiency virus-infected children may benefit from strategies to implement cleaner fuels in order to reduce their HAP exposure.