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Processing of Bronchoalveolar Lavage Fluid and Matched Blood for Alveolar Macrophage and CD4+ T-cell Immunophenotyping and HIV Reservoir Assessment
Published on: June 23, 2019
Chronic radiographic lung changes in children with vertically transmitted HIV-1 infection
K I Norton1, M Kattan, J S Rao
1Department of Radiology, Mount Sinai School of Medicine, One Gustave Levy Pl., New York, NY 10029, USA.
Insights
Chronic radiographic lung changes (CRC) are increasingly common in children with human immunodeficiency virus type 1 (HIV-1) infection. Their resolution may signal worsening immune status, not clinical improvement.
Area of Science:
- Pediatric infectious diseases
- Pulmonology
- Immunology
Background:
- Maternally transmitted human immunodeficiency virus type 1 (HIV-1) infection affects children globally.
- Chronic radiographic lung changes (CRC) are a potential complication in HIV-1-infected children.
- Understanding the incidence and clinical correlation of CRC is crucial for patient management.
Purpose of the Study:
- To determine the incidence of chronic radiographic lung changes (CRC) in children with and without HIV-1 infection.
- To correlate the presence and resolution of CRC with clinical assessments in HIV-1-infected children.
Main Methods:
- Prospective study of 3050 chest radiographs from children born to HIV-1-infected mothers between 1990 and 1997.
- Categorization into HIV-1-infected (Group I) and HIV-1-uninfected (Group IIb) cohorts, with a subgroup of HIV-1-infected children identified later (Group IIa).
- Standardized scoring of radiographs for CRC, defined by duration of specific lung abnormalities; clinical assessments included CD4 counts, viral load, and respiratory symptoms.
Main Results:
- The cumulative incidence of CRC in HIV-1-infected children reached 32.8% by age 4, with increased bronchovascular markings/reticular densities being most frequent.
- CRC were significantly associated with lower CD4 cell counts and higher viral loads in HIV-1-infected children.
- Resolution of CRC correlated with declining CD4 counts, but not with improved clinical findings, viral load, or survival rates.
Conclusions:
- Chronic radiographic lung changes (CRC) are becoming more prevalent in HIV-1-infected children due to increased survival.
- The resolution of CRC in this population may indicate immunologic deterioration rather than clinical improvement.
- Further research is needed to understand the long-term implications of CRC in pediatric HIV-1 infection.
Objective:
We prospectively studied children with and without maternally transmitted HIV-1 infection born to mothers infected with HIV-1 to determine the incidence of chronic radiographic lung changes (CRC) and to correlate these changes with clinical assessments.
Subjects And Methods:
Between 1990 and 1997, we scored 3050 chest radiographs using a standardized form. Group I children (n = 201) were HIV-1-infected at enrollment. Group II children (n = 512) were enrolled prenatally or before 28 days postpartum and subsequently subdivided into group IIa (n = 86), children identified as HIV-1-infected; and group IIb (n = 426), those who were HIV-1-uninfected. CRC were defined as parenchymal consolidations or nodular disease lasting 3 months or more or increased bronchovascular markings or reticular densities lasting 6 months or more. Morbidity was assessed by CD4 counts, viral load, the presence of low oxygen saturation, wheezing, tachypnea, crackles, and clubbing.
Results:
The cumulative incidence of chronic radiographic lung changes in HIV-1-infected children was 32.8% by 4 years old, with increased bronchovascular markings or reticular densities being most common. Chronic changes were associated with lower CD4 cell counts and higher viral loads. Resolution of these chronic changes was associated with decreasing CD4 cell counts but not with lower rates of clinical findings, viral load, or difference in survival.
Conclusion:
With increased survival, CRC are becoming more common. The resolution of these changes may indicate immunologic deterioration rather than clinical improvement.
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