Lung function in HIV-infected children and adolescents

Pneumonia, Jun 2018

Background The advent of antiretroviral therapy has led to the improved survival of human immunodeficiency virus (HIV)-infected children to adulthood and to HIV becoming a chronic disease in older children and adolescents. Chronic lung disease is common among HIV-infected adolescents. Lung function measurement may help to delineate the spectrum, pathophysiology and guide therapy for HIV-related chronic lung disease. Aim The aim of this study was to review the available data on the spectrum and determinants of lung function abnormalities and the impact of antiretroviral therapy on lung function in perinatally HIV-infected children and adolescents. Methods Electronic databases “PUBMED”, “African wide” and “CINAHL” via EBSCO Host, using the MeSH terms “Respiratory function” AND “HIV” OR “Acquired Immunodeficiency Syndrome” AND “Children” OR “Adolescents”, were searched for relevant articles on lung function in HIV-infected children and adolescents. The search was limited to English language articles published between January 1984 and September 2017. Results Eighteen articles were identified, which included studies from Africa, the United States of America (USA) and Italy, representing 2051 HIV-infected children and adolescents, 68% on antiretroviral therapy, aged from 50 days to 24 years. Lung function abnormalities showed HIV-infected participants had increased irreversible lower airway expiratory obstruction and reduced functional aerobic impairment on exercise, compared to HIV-uninfected participants. Mosaic attenuation, extent of bronchiectasis, history of previous pulmonary tuberculosis or previous lower respiratory tract infection and cough for more than 1 month were associated with low lung function. Pulmonary function tests in children established on antiretroviral therapy did not show aerobic impairment and had less severe airway obstruction. Conclusion There is increasing evidence that HIV-infected children and adolescents have high prevalence of lung function impairment, predominantly irreversible lower airway obstruction and reduced aerobic function.

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Lung function in HIV-infected children and adolescents

Githinji et al. Pneumonia Lung function in HIV-infected children and adolescents Leah N. Githinji 0 Diane M. Gray 0 Heather J. Zar 0 0 Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Research Unit on Child and Adolescent Health, University of Cape Town , Rondebosch, Klipfontein Road 7700, Cape Town , South Africa Background: The advent of antiretroviral therapy has led to the improved survival of human immunodeficiency virus (HIV)-infected children to adulthood and to HIV becoming a chronic disease in older children and adolescents. Chronic lung disease is common among HIV-infected adolescents. Lung function measurement may help to delineate the spectrum, pathophysiology and guide therapy for HIV-related chronic lung disease. Aim: The aim of this study was to review the available data on the spectrum and determinants of lung function abnormalities and the impact of antiretroviral therapy on lung function in perinatally HIV-infected children and adolescents. Methods: Electronic databases “PUBMED”, “African wide” and “CINAHL” via EBSCO Host, using the MeSH terms “Respiratory function” AND “HIV” OR “Acquired Immunodeficiency Syndrome” AND “Children” OR “Adolescents”, were searched for relevant articles on lung function in HIV-infected children and adolescents. The search was limited to English language articles published between January 1984 and September 2017. Results: Eighteen articles were identified, which included studies from Africa, the United States of America (USA) and Italy, representing 2051 HIV-infected children and adolescents, 68% on antiretroviral therapy, aged from 50 days to 24 years. Lung function abnormalities showed HIV-infected participants had increased irreversible lower airway expiratory obstruction and reduced functional aerobic impairment on exercise, compared to HIV-uninfected participants. Mosaic attenuation, extent of bronchiectasis, history of previous pulmonary tuberculosis or previous lower respiratory tract infection and cough for more than 1 month were associated with low lung function. Pulmonary function tests in children established on antiretroviral therapy did not show aerobic impairment and had less severe airway obstruction. Conclusion: There is increasing evidence that HIV-infected children and adolescents have high prevalence of lung function impairment, predominantly irreversible lower airway obstruction and reduced aerobic function. HIV; Lung function; Children; Adolescents Background Improved survival of perinatally human immunodeficiency virus (HIV)-infected children to adolescence has occurred with the scale-up of pediatric antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) programs. This has led to a large cohort of youth living with vertically transmitted HIV in sub-Saharan Africa [ 1 ]. Of the 2.3 million children living with HIV globally, 43% are on ART [ 2, 3 ]. In 2016, 7 million people were reported to be living with HIV in South Africa, of which 350,000 were between 10 and 19 years old [2]. HIV-related chronic lung disease (CLD) is a major cause of morbidity and mortality [ 4, 5 ]. In the post-ART era, the spectrum of CLD has changed from lymphocytic interstitial pneumonitis (LIP) being most predominant to bronchiolitis obliterans and bronchiectasis being more prevalent patterns [ 5, 6 ]. The spectrum of chronic lung disease in HIV infection has broad clinical phenotypes. For example, bronchiolitis obliterans may present as an obstructive pattern on spirometry [ 5 ], while chronic Pneumocystis jirovecii pneumonia (PCP), pulmonary tuberculosis (TB), bronchiectasis or LIP have a restrictive or mixed pattern spirometry. Interstitial pneumonitis, LIP and PCP are likely to lead to a reduced diffusion capacity for carbon monoxide (DLCO). Comprehensive lung function measures are therefore needed to delineate the spectrum of CLD, monitor progression, and guide therapy and treatment response. These include measurements of lung capacities and flow, such as spirometry and bronchodilator response testing; measurement of lung volumes with plethysmography; measurement of resistance and compliance with tests such as the forced oscillation technique (FOT), interrupter technique or single-breath occlusion technique; measurement of gas diffusion with single-breath carbon monoxide lung diffusion test to assess alveolar-capillary membrane function; measurement of ventilation distribution with multiple breath nitrogen wash-out test (MBW); and cardiopulmonary functional assessment with the six-minute walk test (6MWT) and exercise (treadmill) testing. The aim of this study was to review the available data on the spectrum and determinants of lung function abnormalities in perinatally HIV-infected children and adolescents. Methods A review of published literature was performed by searching “PUBMED”, “African wide” and “CINAHL” via EBSCO Host using the MeSH terms “Respiratory functio (...truncated)


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Leah N. Githinji, Diane M. Gray, Heather J. Zar. Lung function in HIV-infected children and adolescents, Pneumonia, 2018, pp. 6, Volume 10, Issue 1, DOI: 10.1186/s41479-018-0050-9