Chronic lung disease in HIV-infected children established on antiretroviral therapy
Jamie Rylance1, Grace Mchugh, John Metcalfe
1aLiverpool School of Tropical Medicine, Liverpool, UK bBiomedical Research and Training Institute, Harare, Zimbabwe cUniversity of California, San Francisco, San Francisco, California, USA dUniversity of Zimbabwe, Harare, Zimbabwe eUniversity of Oxford, Oxford fLondon School of Hygiene and Tropical Medicine gRoyal Free Hospital, London, UK.
Insights
Children with HIV experience frequent respiratory symptoms and reduced exercise capacity, even with antiretroviral therapy (ART). Further research is needed to understand the causes and develop new treatments for pediatric HIV-related lung disease.
Area of Science:
- Pediatric infectious diseases
- Pulmonology
- Immunology
Background:
- Respiratory diseases are a significant cause of illness and death in children with HIV.
- Antiretroviral therapy (ART) has improved outcomes, but chronic symptoms persist in some children.
- Understanding long-term respiratory complications in children on ART is crucial.
Purpose of the Study:
- To assess the prevalence of respiratory symptoms, lung function, and exercise capacity in children with HIV on ART.
- To compare these outcomes with an age-matched group of HIV-uninfected children.
- To identify factors associated with respiratory impairment in pediatric HIV.
Main Methods:
- A cross-sectional study involving 202 HIV-infected children and 150 HIV-uninfected children (aged 6-16 years) in Zimbabwe.
- Data collection included standardized questionnaires, spirometry, incremental shuttle walk testing, CD4 counts, HIV viral load, and tuberculosis testing.
- Statistical analysis compared outcomes between the two groups.
Main Results:
- HIV-infected children reported significantly more chronic respiratory symptoms (25% vs 0.7%), particularly cough and dyspnea.
- HIV-infected children had lower exercise capacity (771m vs 889m) and more abnormal spirometry results (24.3% vs 11.5%).
- A history of tuberculosis treatment was more common in HIV-infected children (38% vs 0.7%).
Conclusions:
- Despite ART, HIV infection in children is linked to substantial respiratory symptoms and functional deficits.
- Delayed HIV diagnosis was associated with poorer lung function.
- New therapeutic strategies are urgently needed to address the ongoing respiratory burden in pediatric HIV.
Objective:
Respiratory disease is a major cause of morbidity and mortality in HIV-infected children. Despite antiretroviral therapy (ART), children suffer chronic symptoms. We investigated symptom prevalence, lung function and exercise capacity among older children established on ART and an age-matched HIV-uninfected group.
Design:
A cross-sectional study in Zimbabwe of HIV-infected children aged 6-16 years receiving ART for over 6 months and HIV-uninfected children attending primary health clinics from the same area.
Methods:
Standardized questionnaire, spirometry, incremental shuttle walk testing, CD4 cell count, HIV viral load and sputum culture for tuberculosis were performed.
Results:
A total of 202 HIV-infected and 150 uninfected participants (median age 11.1 years in each group) were recruited. Median age at HIV diagnosis and ART initiation was 5.5 (interquartile range 2.8-7.5) and 6.1 (interquartile range 3.6-8.4) years, respectively. Median CD4 cell count was 726 cells/μl, and 79% had HIV viral load less than 400 copies/ml. Chronic respiratory symptoms were rare in HIV-uninfected children [n = 1 (0.7%)], but common in HIV-infected participants [51 (25%)], especially cough [30 (15%)] and dyspnoea [30 (15%)]. HIV-infected participants were more commonly previously treated for tuberculosis [76 (38%) vs 1 (0.7%), P < 0.001], had lower exercise capacity (mean incremental shuttle walk testing distance 771 vs 889 m, respectively, P < 0.001) and more frequently abnormal spirometry [43 (24.3%) vs 15 (11.5%), P = 0.003] compared with HIV-uninfected participants. HIV diagnosis at an older age was associated with lung function abnormality (P = 0.025). No participant tested positive for Mycobacterium tuberculosis.
Conclusion:
In children, despite ART, HIV is associated with significant respiratory symptoms and functional impairment. Understanding pathogenesis is key, as new treatment strategies are urgently required.
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