Surgery for bronchiectasis in children living with HIV: A case series from a low- to middle-income country
Related Experiment Video
Updated: Jun 5, 2025
Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
H Peens-Hough1, P Goussard2, D Rhode2
1Division of Cardiothoracic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
Insights
Surgical resection for bronchiectasis in children with HIV is safe and effective, significantly improving symptoms with a low complication rate. This approach offers a viable option for managing this condition in affected children.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Pulmonology
Background:
- Bronchiectasis (BE) significantly impacts morbidity and mortality in children living with HIV (CLWH), particularly in tuberculosis-endemic regions.
- Current treatments for BE in CLWH primarily focus on infection prevention and symptom management, with limited consideration for surgical intervention.
Purpose of the Study:
- To detail the indications for and complications associated with surgical resection of BE in CLWH.
- To identify factors that influence patient outcomes following surgery for BE in this population.
Main Methods:
- A retrospective review of medical records for CLWH aged 14 years or younger who underwent surgical resection for BE.
- Data collected included immune status, antiretroviral treatment (ART) status, prior tuberculosis (TB) treatment, and operative/postoperative outcomes.
Main Results:
- Twelve CLWH on ART with symptomatic BE underwent surgical resection, with a mean age of 7 years and a mean CD4 count of 970 cells/µL.
- Indications included recurrent infections, chronic cough, and persistent lobar collapse; common procedures were left lower lobe lobectomy (42%) and pneumonectomy (17%).
- Complications were minimal (one case of persistent pneumothorax), with no deaths and significant symptom improvement in 83% of patients.
Conclusions:
- Surgical resection for BE in CLWH is a safe procedure with a low complication rate.
- The findings indicate significant postoperative improvement in respiratory symptoms for children undergoing surgical intervention for BE.
Background:
Bronchiectasis (BE) in children living with HIV (CLWH) remains a significant cause of morbidity and mortality, especially in tuberculosis (TB)-endemic low- and middle-income countries. Treatment modalities for BE in CLWH currently focus mainly on prevention of infections and management of symptoms, while surgical management is indicated for a select group. In contrast, surgical management in non-cystic fibrosis BE is well established.
Objectives:
To describe the indications for and complications of surgical resection for BE in CLWH, and to identify variables influencing outcome.
Methods:
A retrospective medical records review was conducted of all CLWH aged ≤14 years who underwent surgical resection for BE at Tygerberg Hospital, Cape Town, South Africa, between 1 January 2007 and 30 September 2014. The variables collected included immune status, antiretroviral treatment (ART), previous treatment for TB, operative and postoperative complications, and postoperative symptom relief.
Results:
Twelve CLWH on ART with symptomatic BE underwent surgical resection. The mean age was 7 years and the mean CD4 count 970 cells/µL. Indications for surgery included recurrent infections, chronic cough and persistent lobar collapse. The most common procedures were left lower lobe lobectomy (42%), left pneumonectomy (17%) and right bilobectomy (17%). Complications were limited to persistent pneumothorax after surgery in one child. There were no deaths. Ten children (83%) showed significant improvement of symptoms at follow-up.
Conclusion:
Surgical resection for BE in CLWH can be performed safely with a low complication rate, resulting in significant improvement of symptoms postoperatively.
Study Synopsis:
What the study adds. Bronchiectasis (BE) in children living with HIV (CLWH) is a significant cause of morbidity and mortality. Current treatment focuses on preventing infections and managing symptoms, while surgical management is rarely considered. A retrospective medical records review of 12 children aged ≤14 years in South Africa found that surgical resection for BE can be performed with a low complication rate, resulting in significant improvement of symptoms postoperatively. Variables influencing outcome include immune status, antiretroviral treatment and previous treatment for tuberculosis.Implications of the findings. This study demonstrates that surgery for BE can be performed safely in CLWH, with significant improvement of respiratory symptoms postoperatively.
More Related Videos
07:28Donor Posterior Atrial Flap Rotation for Left Atrial Cuff Reconstruction in Lung Transplantation
Published on: October 11, 2024
07:21Processing of Bronchoalveolar Lavage Fluid and Matched Blood for Alveolar Macrophage and CD4+ T-cell Immunophenotyping and HIV Reservoir Assessment
Published on: June 23, 2019
Related Concept Videos
01:30Endoscopic Studies I: Bronchoscopy and Thoracoscopy
Bronchoscopy
Description
Bronchoscopy is a procedure that involves direct visualization of the larynx, trachea, and bronchi for diagnostic and therapeutic purposes. A flexible fiber optic or rigid bronchoscope is used to carry out the procedure. The fiber-optic bronchoscope is more frequently used due...
01:24Cystic Fibrosis: Management
Sinus disease and chronic...
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...
01:27Pneumothorax-II
Clinical Manifestations:
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...