149. Higher Exposure to Household Air Pollution is Associated with Acute Lower Respiratory Illness in HIV-infected Kenyan Infants
Session: Poster Abstract Session: Big Viruses in Little People (Pediatric Viral Diseases)
Thursday, October 27, 2016
Room: Poster Hall

Background: Household air pollution (HAP) impacts early childhood health and mortality, however, the impact of HAP on early childhood respiratory illness in HIV-infected children has not been defined.

Methods: HIV-infected children initiated antiretroviral therapy (ART) at ≤12 months and had monthly assessment of respiratory conditions during 24-months of follow-up in Nairobi, Kenya. At school-age, 24-hour sampling of caregiver personal exposure (as a proxy for child exposure) to respirable particulate matter <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 (IQR, 613, 7.3) and 56% were male. Among 35 households with 24-hour sampling, mean personal PM2.5 exposure was 22.7 ug/m3 (IQR, 12.2, 51.9), and maximum was 612 ug/m3 (IQR, 286, 1093). Nearly half (42%) had 24 hour mean PM2.5 exposure above the WHO safe air quality threshold (PM2.5 ≥25 ug/m3), and 27% had maximums ≥1,000ug/m3. HIV-infected children with a maximum PM2.5 exposure ≥1,000 ug/m3 had a 4-fold increased risk of pneumonia (HR 4.2, 95% CI, 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. HIV-infected children may benefit from strategies to implement cleaner fuels in order to reduce their HAP exposure.

Laurén Gómez, B.S.1, Grace C. John-Stewart, MD, PhD2, Dalton Wamalwa, MBChB, MMed, MPH3, Kenneth Tapia, MS4, Agnes Langat, MBChB, MMed3, Helen Moraa, BSN5, Duke Nyatika, BSN6, Catherine Karr, PHD, MD, MS7, Elizabeth Maleche-Obimbo, MB ChB M.Med (Paed); MPH3 and Sarah Benki-Nugent, PhD, MS1, (1)Department of Global Health, University of Washington, Seattle, WA, (2)Departments of Medicine, Epidemiology and Global Health, University of Washington, Seattle, WA, (3)Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya, (4)University of Washington, Seattle, WA, (5)Departments of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya, (6)University of Nairobi, Nairobi, Kenya, (7)Departments of Pediatrics,Environmental and Occupational Health Sciences, and Epidemiology, University of Washington, Seattle, WA

Disclosures:

L. Gómez, None

G. C. John-Stewart, None

D. Wamalwa, None

K. Tapia, None

A. Langat, None

H. Moraa, None

D. Nyatika, None

C. Karr, None

E. Maleche-Obimbo, None

S. Benki-Nugent, None

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