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Persistent and chronic lung disease in HIV-1 infected and uninfected African children
P M Jeena1, H M Coovadia, S A Thula
1Department of Paediatrics and Child Health, Faculty of Medicine, University of Natal, Durban, South Africa.
Insights
Persistent and chronic lung disease in children in developing countries are often linked to HIV. Identifying infectious agents like tuberculosis is crucial for effective treatment in these vulnerable populations.
Area of Science:
- Pediatric Respiratory Medicine
- Infectious Diseases in Children
- HIV/AIDS Research
Background:
- The etiology of persistent lung disease (PLD) and chronic lung disease (CLD) in HIV-infected children in developing nations remains largely uncharacterized.
- Understanding these lung conditions is critical for improving patient outcomes and guiding clinical management strategies.
Purpose of the Study:
- To investigate and describe the causes and clinical course of PLD and CLD in both HIV-infected and HIV-uninfected children in a developing country setting.
- To provide initial data on the specific etiological agents responsible for chronic lung conditions in this population.
Main Methods:
- A 2-year prospective study of 194 children with lung disease (PLD ≥ 1 month, CLD ≥ 3 months) at a pediatric respiratory clinic.
- Invasive investigations were performed on 42 children who did not respond to initial management for over 3 months.
Main Results:
- HIV infection was present in 71% of children with PLD. Lymphoid interstitial pneumonitis (57%) and tuberculosis (29%) were the primary causes of CLD in HIV-infected children.
- In HIV-uninfected children with CLD, tuberculosis and interstitial pneumonitis were equally prevalent (29% each), followed by bronchiectasis (22%).
Conclusions:
- This study presents the first data on the causes of CLD in HIV-infected children in a developing country.
- Prompt identification of infectious agents, including Mycobacterium tuberculosis and secondary bacterial infections in lymphoid interstitial pneumonitis, is essential for optimal treatment of pediatric lung disease.
Objective:
The causes of persistent lung disease (PLD) and chronic lung disease (CLD) are unknown in HIV-infected children in developing countries. We describe the causes and course of PLD and CLD in HIV-infected and uninfected children.
Method:
Of 194 children with lung disease persisting for at least 1 month who were seen at the paediatric respiratory clinic over a 2-year period, 42 underwent invasive investigations after failed initial management over 3 months. PLD was defined as the presence of clinical and radiological features of lung disease for more than 1 month, and CLD as these features for more than 3 months.
Results:
One hundred and thirty-eight (71%) of the 194 children with PLD were HIV-infected, 52 (27%) were not infected and four (2%) were of undetermined HIV status. Forty-eight per cent of the HIV-infected children and 52% of the HIV-uninfected children responded to initial treatment over 3 months; the presumptive diagnoses in these were tuberculosis, interstitial pneumonitis, bronchiectasis and post-ventilation lung syndrome. Of the 28 HIV-infected children with CLD who underwent invasive investigations 16 (57%) had lymphoid interstitial pneumonitis, eight (29%) had tuberculosis and four (14%) had non-specific interstitial pneumonitis. Of the 14 HIV-uninfected children with CLD who had invasive testing there were four cases (29%) each of tuberculosis and interstitial pneumonitis, three (22%) cases of bronchiectasis and one case of each of extrinsic allergic alveolitis, crytogenic fibrosing alveolitis and non-Hodgkin's lymphoma.
Conclusion:
This is the first set of data on the causes of CLD in HIV-infected children in a developing country. Every effort should be made to identify the infectious agent, whether M. tuberculosis or a secondary bacterial infection in LIP, in order to treat most appropriately these children with lung disease.