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Chronic lung disease in HIV-infected children established on antiretroviral therapy

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Rylance, Jamie ORCID: https://orcid.org/0000-0002-2323-3611, McHugh, Grace, Metcalfe, John, Mujuru, Hilda, Nathoo, Kusum, Wilmore, Stephanie, Rowland-Jones, Sarah, Majonga, Edith, Kranzer, Katharina and Ferrand, Rashida A (2016) 'Chronic lung disease in HIV-infected children established on antiretroviral therapy'. AIDS, Vol 30, Issue 18, pp. 2795-2803.

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Abstract

Objective
Respiratory disease is a major cause of morbidity and mortality in HIV-infected children. Despite antiretroviral therapy (ART), children suffer chronic symptoms. We investigated symptom prevalence, lung function, and exercise capacity among older children established on ART, and an age-matched HIV-uninfected group.

Design
A cross-sectional study in Zimbabwe of: 1) HIV-infected children aged 6-16 years receiving ART for over six months; 2) HIV-uninfected children attending primary health clinics from the same area.

Methods
Standardised questionnaire, spirometry, Incremental Shuttle Walk Testing (ISWT), CD4 count, HIV viral load, and sputum culture for tuberculosis were performed.

Results
202 HIV-infected and 150 uninfected participants (median age 11.1 years in each group) were recruited. Median age at HIV diagnosis and ART initiation was 5.5 (IQR 2.8-7.5) and 6.1 years (IQR 3.6-8.4) respectively. Median CD4 count was 726 cells/µl, and 79% had HIV viral load<400copies/ml. Chronic respiratory symptoms were rare in HIV-uninfected children (n=1 [0.7%]), but common in HIV-infected participants (51 [25%]), especially cough (30 [15%]) and dyspnoea (30 [15%]). HIV-infected participants were more commonly previously treated for tuberculosis (76 [38%] versus 1 [0.7%], p<0.001), had lower exercise capacity (mean ISWT distance 771m versus 889m respectively, p<0.001), and more frequently abnormal spirometry (43 [24.3%] versus 15 [11.5%], p=0.003) compared to HIV-uninfected participants. HIV diagnosis at an older age was associated with lung function abnormality (p=0.025). No participant tested positive for M. tuberculosis.

Conclusions
In children, despite ART, HIV is associated with significant respiratory symptoms and functional impairment. Understanding pathogenesis is key, as new treatment strategies are urgently required.

Item Type: Article
Uncontrolled Keywords: HIV, Sub-Saharan Africa, Lung Function, Chronic lung disease, Antiretroviral therapy (ART)
Subjects: WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WF Respiratory System > WF 140 Diseases of the respiratory system (General)
WF Respiratory System > Lungs > WF 600 Lungs
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
Digital Object Identifer (DOI): https://doi.org/10.1097/QAD.0000000000001249
Depositing User: Jessica Jones
Date Deposited: 07 Sep 2016 16:06
Last Modified: 26 Aug 2017 01:02
URI: http://archive.lstmed.ac.uk/id/eprint/6099

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