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Effect of antiretroviral therapy on longitudinal lung function trends in older children and adolescents with HIV-infection

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Rylance, Sarah, Rylance, Jamie ORCID: https://orcid.org/0000-0002-2323-3611, McHugh, Grace, Majonga, Edith, Bandason, Tsitsi, Mujuru, Hilda, Nathoo, Kusum, Rowland-Jones, Sarah, Henrion, Marc, Simms, Victoria and Ferrand, Rashida A. (2019) 'Effect of antiretroviral therapy on longitudinal lung function trends in older children and adolescents with HIV-infection'. PLoS ONE, Vol 14, Issue 3, e0213556.

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Abstract

Introduction
Chronic respiratory disease is a common cause of morbidity in children with HIV infection. We investigated longitudinal lung function trends among HIV-infected children, to describe the evolution of lung disease and assess the effect of anti-retroviral therapy (ART).
Methods
Prospective follow-up of two cohorts of HIV-infected children, aged 6 to 16 years, in Harare, Zimbabwe; one group were ART-naïve at enrolment, the other established on ART for a median of 4.7-years. Standardised spirometric assessments were repeated over a 2-year follow-up period. Forced expiratory volume (FEV1) and forced vital capacity (FVC) were expressed as Global Lung Initiative defined z-scores (FEV1z and FVCz). Linear mixed-effects regression modelling of lung function was performed, with co-variate parameters evaluated by likelihood ratio comparison.
Results
We included 271 ART-naïve and 197 ART-established children (median age 11 years in both groups) incorporating 1144 spirometric assessments. Changes in FEV1 and FVC were associated with age at ART initiation and body mass index for both cohorts. Our models estimate that ART initiation earlier in life could prevent a deterioration of 0.04 FVCz/year. In the ART-naïve cohort, likelihood ratio comparison suggested an improvement in 0.09 FVCz/year during the two years following treatment initiation, but no evidence for this among participants established on ART.
Conclusion
Early ART initiation and improved nutrition are positively associated with lung function and are important modifiable factors. An initial improvement in lung growth was seen in the first 2-years following ART initiation, although this did not appear to be sustained beyond this timeframe.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.5 Complications
WF Respiratory System > Lungs > WF 600 Lungs
WS Pediatrics > Diseases of Children and Adolescents > By System > WS 340 Nervous system
WS Pediatrics > By Age Groups > WS 460 Adolescence (General)
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pone.0213556
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 22 Mar 2019 12:03
Last Modified: 06 Dec 2019 16:09
URI: https://archive.lstmed.ac.uk/id/eprint/10444

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