Long-term pulmonary complications in perinatally HIV-infected youth
William T Shearer1, Denise L Jacobson2, Wendy Yu2
1Department of Pediatrics, Baylor College of Medicine, and the Department of Allergy and Immunology, Texas Children's Hospital, Houston, Tex.
Insights
HIV-infected youth show reduced lung function reversibility, unlike typical asthma. This may signal early chronic obstructive pulmonary disease (COPD), requiring long-term monitoring in these young patients.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Immunology
Background:
- Perinatally HIV-infected youth exhibit higher rates of asthma compared to HIV-exposed uninfected (HEU) youth.
- Understanding pulmonary function in this population is crucial for long-term health management.
Purpose of the Study:
- To conduct objective pulmonary function tests (PFTs) in HIV-infected and HEU youth.
- To compare PFT outcomes between HIV-infected and HEU youth, with and without diagnosed asthma.
Main Methods:
- 370 participants (218 HIV-infected, 152 HEU) underwent asthma assessment via chart review and self-report.
- Interpretable PFTs were analyzed for obstructive, restrictive, or normal patterns, with bronchodilator reversibility assessed.
- Biomarkers including HIV viral load, CD4/CD8 counts, IgE levels, and cotinine were measured.
Main Results:
- No significant difference in obstructive lung disease prevalence between HIV-infected and HEU youth.
- HIV-infected youth were less likely to show reversibility of obstructive lung disease post-bronchodilator (9% vs 17%).
- HIV-infected youth had lower CD4/CD8 T-cell ratios and reduced association of specific IgE to allergens.
Conclusions:
- HIV-infected youth demonstrate atypical obstructive lung disease reversibility, potentially indicating early chronic obstructive pulmonary disease (COPD).
- Further longitudinal studies are necessary to fully characterize the pulmonary outcomes for HIV-infected youth into adulthood.
Background:
Increased incidence and prevalence of asthma have been documented for perinatally HIV-infected youth 10 to 21 years of age compared with HIV-exposed uninfected (HEU) youth.
Objective:
We sought to perform objective pulmonary function tests (PFTs) in HIV-infected and HEU youth with and without diagnosed asthma.
Method:
Asthma was determined in 370 participants (218 HIV-infected and 152 HEU participants) by means of chart review and self-report at 13 sites. Interpretable PFTs (188 HIV-infected and 132 HEU participants) were classified as obstructive, restrictive, or normal, and reversibility was determined after bronchodilator inhalation. Values for HIV-1 RNA, CD4 and CD8 T cells, eosinophils, total IgE, allergen-specific IgE, and urinary cotinine were measured. Adjusted prevalence ratios (PRs) of asthma and PFT outcomes were determined for HIV-infected participants relative to HEU participants, controlling for age, race/ethnicity, and sex.
Results:
Current asthma was identified in 75 (34%) of 218 HIV-infected participants and 38 (25%) of 152 HEU participants (adjusted PR, 1.33; P = .11). The prevalence of obstructive disease did not differ by HIV status. Reversibility was less likely in HIV-infected youth than in HEU youth (17/183 [9%] vs 21/126 [17%]; adjusted PR, 0.47; P = .020) overall and among just those with obstructive PFT results (adjusted PR, 0.46; P = .016). Among HIV-infected youth with current asthma, serum IgE levels were inversely correlated with CD8 T-cell counts and positively correlated with eosinophil counts and not associated with CD4 T-cell counts. HIV-infected youth had lower association of specific IgE levels to several inhalant and food allergens compared with HEU participants and significantly lower CD4/CD8 T-cell ratios (suggesting immune imbalance).
Conclusion:
Compared with HEU youth, HIV-infected youth demonstrated decreased reversibility of obstructive lung disease, which is atypical of asthma. This might indicate an early stage of chronic obstructive pulmonary disease. Follow-up into adulthood is warranted to further define their pulmonary outcomes.
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