Clinical Characteristics and Lung Function in Older Children Vertically Infected With Human Immunodeficiency Virus in
Thandie Mwalukomo1, Sarah J Rylance2, Emily L Webb3
1College of Medicine, University of Malawi London School of Hygiene & Tropical Medicine, United Kingdom.
Insights
Children with vertically acquired human immunodeficiency virus (HIV) often have chronic respiratory symptoms. This study found common lung function abnormalities in HIV-positive children, suggesting a need for better diagnostic approaches.
Area of Science:
- Pediatric pulmonology
- Infectious diseases
- Public health
Background:
- Antiretroviral therapy (ART) has improved survival for children with vertically acquired human immunodeficiency virus (HIV).
- Respiratory symptoms are a significant source of morbidity in this population, yet their causes and impact on pulmonary function are not well understood.
Purpose of the Study:
- To systematically investigate the aetiology of respiratory symptoms and assess pulmonary function abnormalities in children with vertically acquired HIV.
Main Methods:
- Recruited 160 HIV-positive children (aged 8-16 years) in Blantyre, Malawi.
- Conducted clinical reviews, quality of life assessments, spirometry, and chest radiography.
- Analyzed data to identify respiratory symptoms, lung function parameters, and radiographic findings.
Main Results:
- 37.5% reported cough, 34.4% experienced dyspnea, and 20.6% were hypoxic at rest.
- Spirometry revealed significant abnormalities, including obstructive defects (14.5%) and reduced forced vital capacity (17.9%), with limited response to bronchodilators.
- Chest radiographs showed abnormalities in over half of the participants, including "tramlines" and ring shadows.
Conclusions:
- Chronic lung disease symptoms are highly prevalent in HIV-positive children, presenting as "cough" or "hypoxia" phenotypes.
- Common lung function abnormalities are poorly responsive to bronchodilators and present across the age range.
- Further research is needed to elucidate pathological causes and validate these phenotypes for diagnostic use.
Background:
Antiretroviral therapy (ART) has led to increased survival of children with vertically acquired human immunodeficiency virus infection. Significant morbidity arises from respiratory symptoms, but aetiology and pulmonary function abnormalities have not been systematically studied.
Methods:
Human immunodeficiency virus-positive children aged 8-16 years were systematically recruited within clinics in Blantyre, Malawi. Clinical review, quality of life assessment, spirometry, and chest radiography were performed.
Results:
One hundred sixty participants had a mean of age 11.1 (range, 8-16) years and 50.0% were female. Cough was present in 60 (37.5%) participants, and 55 (34.4%) had moderate or severe dyspnoea. Thirty-four (22.1%) participants had digital clubbing. Thirty-three (20.6%) participants were hypoxic at rest. One hundred eighteen (73.8%) of the children were receiving ART; median CD4 count was 698 cells/µL in these compared with 406 cells/µL in ART-naive individuals (P < .001). From 145 spirometry traces (90.6%), mean forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were 1.06 and 0.89 standard deviations below predicted mean, respectively. Twenty-one (14.5%) traces demonstrated obstructive defects and 26 (17.9%) reduced FVC. Lung function abnormality was not associated with any clinical findings. Of the 51 individuals with abnormal lung function, the mean increase in FEV1 after salbutamol was 3.8% (95% confidence interval, 0.02-7.53). "Tramlines" and ring shadows were seen on chest radiographs in over half of cases.
Conclusions:
Symptoms of chronic lung disease were highly prevalent with 2 main clinical phenotypes: "cough" and "hypoxia". Lung function abnormalities are common, poorly responsive to bronchodilators, and apparent throughout the age range of our cohort. Pathological causes remain to be elucidated. Cough and hypoxic phenotypes could be a useful part of diagnostic algorithms if further validated.
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