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Respiratory morbidity from lymphocytic interstitial pneumonitis (LIP) in vertically acquired HIV infection
M Sharland1, D M Gibb, F Holland
1Paediatric Infectious Disease Unit, St George's Hospital, London.
Insights
Children with lymphocytic interstitial pneumonitis (LIP) and HIV infection experience higher rates of acute lower respiratory tract infections. Early prevention strategies are crucial for reducing severe respiratory illness in this vulnerable pediatric population.
Area of Science:
- Pediatric Infectious Diseases
- Pulmonology
- Immunology
Background:
- Lymphocytic interstitial pneumonitis (LIP) is a significant respiratory complication in children with vertically acquired human immunodeficiency virus (HIV) infection.
- Understanding the burden of respiratory morbidity associated with LIP is crucial for effective management.
Purpose of the Study:
- To define the respiratory morbidity associated with lymphocytic interstitial pneumonitis (LIP) in children diagnosed with vertically acquired HIV infection.
- To compare the incidence of acute lower respiratory tract infections in children with and without LIP.
Main Methods:
- Retrospective case note review of 95 children with vertically acquired HIV infection from three London hospitals.
- Data collection included clinical and radiological evidence of LIP, acute lower respiratory tract infections, and chronic lung disease.
- Analysis of admission rates for acute lower respiratory tract infections in LIP and non-LIP groups.
Main Results:
- Lymphocytic interstitial pneumonitis (LIP) was diagnosed in 33% of the study cohort.
- Acute lower respiratory tract infection admissions occurred in 42% of children, despite cotrimoxazole prophylaxis.
- Admission rates for acute lower respiratory tract infections were significantly higher in the LIP group (0.38 admissions/child year) compared to the non-LIP group (0.17 admissions/child year).
- Streptococcus pneumoniae and Haemophilus influenzae were the most frequently isolated pathogens.
Conclusions:
- Children with lymphocytic interstitial pneumonitis (LIP) and HIV infection face substantially higher risks of severe respiratory morbidity, particularly acute lower respiratory tract infections.
- Enhanced preventive strategies targeting acute lower respiratory tract infections are essential to mitigate severe respiratory complications in these children.
Abstract:
The aim of the study was to define the respiratory morbidity caused by lymphocytic interstitial pneumonitis (LIP) in children with vertically acquired HIV infection. A retrospective case note review was performed on 95 children attending three London hospitals. Clinical and radiological evidence of LIP, acute lower respiratory tract infections, and chronic lung disease was obtained using a structured protocol. A diagnosis of LIP had been made in 33%, and an acute admission due to acute lower respiratory tract infection had occurred in 42% of all children (despite 99% taking regular cotrimoxazole prophylaxis). Admission rates because of acute lower respiratory tract infection were significantly higher in the LIP group (0.38 admissions/child year) than in the non-LIP group (0.17 admissions/child year) (p = 0.0002). Encapsulated bacteria (Streptococcus pneumoniae, Haemophilus influenzae) were most frequently isolated. Improved methods of prevention of acute lower respiratory tract infection may help to reduce the severe respiratory morbidity seen in children with LIP and HIV infection.