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Bronchiectasis in pediatric AIDS
S Sheikh1, K Madiraju, P Steiner
1Children's Medical Center, Health Science Center, State University of New York at Brooklyn, USA.
Insights
Bronchiectasis occurs in over 15% of children with pediatric AIDS and lung disease. This condition is particularly common in those with lymphocytic interstitial pneumonitis and low CD4+ T-cell counts.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Immunology
Background:
- Pulmonary complications are frequent in children with Human Immunodeficiency Virus (HIV) infection.
- Bronchiectasis is an underreported pulmonary finding in pediatric HIV disease.
Purpose of the Study:
- To evaluate the occurrence of bronchiectasis in children with Acquired Immunodeficiency Syndrome (AIDS) and pneumonopathy.
- To identify risk factors and associated conditions for bronchiectasis in this population.
Main Methods:
- Retrospective review of medical records of 164 children with AIDS and respiratory problems.
- Diagnosis of bronchiectasis confirmed by chest radiograph, CT scan, and histology.
Main Results:
- Bronchiectasis was observed in 15.8% (26/164) of children with AIDS.
- Higher incidence noted in children with lymphocytic interstitial pneumonitis (34.0%), unresolved pneumonia (27.7%), and recurrent pneumonia (12.5%).
- All patients with available CD4+ T-cell counts (< 100 cells/mm³) developed bronchiectasis.
Conclusions:
- Bronchiectasis is a significant pulmonary complication in children with AIDS.
- Lymphocytic interstitial pneumonitis, recurrent/unresolved pneumonia, and severe immunosuppression (CD4+ < 100) are associated with increased risk.
- Early recognition and management of bronchiectasis are crucial in pediatric AIDS patients.
Objectives:
There are several reports of the pulmonary findings in children with HIV disease; however, the occurrence of bronchiectasis rarely has been noted. We evaluated occurrence of bronchiectasis in a large group of children referred to us with AIDS pneumopathy.
Methods:
From January 1984 to April 1996, 203 children with AIDS and respiratory problems were referred to the pediatric pulmonary division at Children's Medical Center of Brooklyn. Medical records for 164 of these children were available and retrospectively reviewed.
Results:
Uncomplicated pneumonia was present in 75, 24 had recurrent pneumonia, and 18 had unresolved pneumonia; lymphocytic interstitial pneumonitis (LIP) was diagnosed in 47 patients, worsening with time in all patients. Bronchiectasis was observed in 26 patients (26/164, 15.8%), diagnosed by chest radiograph in 26 (26/26, 100%), confirmed by CT scan of chest in 10 (10/26, 38.4%), and by histology in three (3/26, 11.5%). Median age at time of diagnosis of bronchiectasis was 7.5 years (range, 1 to 16 years). Sixteen children with LIP developed bronchiectasis (16/47, 34.0%). Three patients with recurrent pneumonia (3/24, 12.5%) developed bronchiectasis. Five patients with unresolved pneumonia (5/18, 27.7%) developed bronchiectasis. One infant developed bronchiectasis after Pneumocystis carinii pneumonia; another child developed bronchiectasis after P. carinii and Mycobacterium tuberculosis pneumonia. The CD4+ T-cell counts measured within 6 months of diagnosis of bronchiectasis were available in 23/26 patients and, all were < 100 cells per cubic millimeter.
Conclusion:
We conclude, from our experience, that there is a significant occurrence of bronchiectasis in children with AIDS and pulmonary disease, especially in children developing LIP, recurrent pneumonia and unresolved pneumonia, and CD4+ T-cell counts < 100 cells per cubic millimeter.