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Human Immunodeficiency Virus-Associated Chronic Lung Disease in Children and Adolescents in Zimbabwe: Chest Radiographic and High-Resolution Computed Tomographic Findings

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Desai, Sujal R, Nair, Arjun, Rylance, Jamie ORCID: https://orcid.org/0000-0002-2323-3611, Mujuru, Hilda, Nathoo, Kusum, McHugh, Grace, Majonga, Edith, Metcalfe, John, Kranzer, Katharina and Ferrand, Rashida (2017) 'Human Immunodeficiency Virus-Associated Chronic Lung Disease in Children and Adolescents in Zimbabwe: Chest Radiographic and High-Resolution Computed Tomographic Findings'. Clinical Infectious Diseases, Vol 66, Issue 2, pp. 274-281.

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Abstract

Background
Chronic respiratory symptoms are common among children living with human immunodeficiency virus (HIV). We investigated the radiological features of chronic lung disease in children aged 6–16 years receiving antiretroviral therapy for ≥6 months in Harare, Zimbabwe.

Methods
Consecutive participants from a HIV clinic underwent clinical assessment and chest radiography. Participants with an abnormal chest radiograph (assessed by a clinician) and/or those meeting a clinical case definition for chronic lung disease underwent high-resolution computed tomography (HRCT). Radiological studies were scored independently and blindly by 2 thoracic radiologists. Relationships between radiological abnormalities and lung function were examined.

Results
Among 193 participants (46% female; median age, 11.2 years; interquartile range, 9.0–12.8 years), the median CD4 cell count was 720/µL (473–947/µL), and 79% had a human immunodeficiency virus (HIV) load of <400 copies/mL. The most common chest radiographic finding was ring/tramline opacities (55 of 193 participants; 29%). HRCT scans were evaluated in 84 participants (69%); decreased attenuation (present in 43%) was the dominant abnormality seen. The extent of decreased attenuation was strongly correlated with both the severity and extent of bronchiectasis (rs = 0.68 and P < .001 for both). The extent of decreased attenuation was also negatively correlated with forced expiratory volume in first second of expiration (rs = –0.52), forced vital capacity (rs = –0.42), and forced expiratory flow, midexpiratory phase (rs = –0.42) (P < .001 for all).

Conclusions
The HRCT findings strongly suggest that obliterative bronchiolitis may be the major cause of chronic lung disease in our cohort. Further studies to understand the pathogenesis and natural history are urgently needed.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 320 Child Welfare. Child Health Services.
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WF Respiratory System > Lungs > WF 600 Lungs
WS Pediatrics > By Age Groups > WS 430 Infancy
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/10.1093/cid/cix778
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 12 Mar 2018 16:24
Last Modified: 12 Mar 2018 16:25
URI: https://archive.lstmed.ac.uk/id/eprint/8355

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