Most Early-Treated Children With Perinatally Acquired HIV Have Preserved Lung Function at School Age
Engi F Attia1, Hellen Moraa2, Elizabeth Maleche-Obimbo2
1Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA.
Insights
Early antiretroviral therapy (ART) in children with perinatally acquired HIV (PHIV) generally preserves lung function. However, some children still experience impaired lung function, highlighting modifiable risk factors for intervention.
Area of Science:
- Pediatric pulmonology
- Infectious diseases
- HIV/AIDS research
Background:
- Impaired lung function is prevalent in children with perinatally acquired HIV (PHIV) who start antiretroviral therapy (ART) late.
- This study investigates lung function in school-aged children with PHIV who initiated ART within the first 12 months of life.
Purpose of the Study:
- To determine the prevalence of abnormal spirometry in school-aged children with PHIV who received early ART.
- To identify cofactors associated with impaired lung function in this cohort.
Main Methods:
- Spirometry (FEV1, FVC) was performed on children receiving early ART.
- Abnormal spirometry was defined using z-scores for obstructive and restrictive patterns.
- Associations between lung function and clinical/environmental factors were analyzed using linear regression.
Main Results:
- Among 40 children, 13% exhibited abnormal spirometry.
- Lower spirometry z-scores were linked to pre-ART pneumonia, advanced HIV stage, higher viral load post-ART initiation, poor anthropometric z-scores, and elevated carbon monoxide exposure.
- The mean spirometry z-scores were largely within the normal range.
Conclusions:
- Early ART initiation in infancy appears to preserve lung function in most children with PHIV.
- Despite early treatment, a subset of children shows abnormal lung function, indicating persistent risks.
- Identifying and addressing modifiable factors like environmental exposures and managing opportunistic infections is crucial for preventing chronic lung disease in PHIV.
Background:
Impaired lung function is common among older children with perinatally acquired HIV (PHIV) who initiated antiretroviral therapy (ART) late in childhood. We determined the prevalence of abnormal spirometry and cofactors for impaired lung function among school-age children with PHIV who initiated ART when aged 12 months or younger.
Setting:
Children who received early ART in the Optimizing Pediatric HIV-1 Therapy study in Kenya and underwent spirometry at school age.
Methods:
Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were measured. Abnormal spirometry was defined as follows: obstructive (FEV1/FVC <1.64 z score [zFEV1/FVC]) and restricted (zFVC <1.64 with zFEV1/FVC ≥1.64). Characteristics, including anthropometric and HIV-related data, were ascertained in infancy and at school age. Caregiver carbon monoxide exposure served as a proxy for school-age child exposure. Linear regression determined associations of cofactors with lung function.
Results:
Among 40 children, the median age was 5 months at ART initiation and 8.5 years at spirometry. The mean zFEV1, zFVC, and zFEV1/FVC (SD) were 0.21 (1.35), 0.31 (1.22), and -0.24 (0.82), respectively. Five (13%) children had abnormal spirometry. Spirometry z scores were significantly lower among children with pre-ART pneumonia, WHO HIV stage 3/4, higher HIV RNA at 6 months after ART initiation, low anthropometric z scores, and higher carbon monoxide exposure.
Conclusions:
Most of the children with PHIV who initiated ART at age 12 months or younger had normal spirometry, suggesting that ART in infancy preserved lung function. However, 13% had abnormal spirometry despite early ART. Modifiable factors were associated with impaired lung function, providing potential targets for interventions to prevent chronic lung disease.
Related Concept Videos
01:28Pulmonary Tuberculosis V
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the...
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:29Pulmonary Tuberculosis I
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
01:10Retrovirus Life Cycles
01:25Transmission-based Precautions II: Airborne and Protective Environment
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....