Most Early-Treated Children With Perinatally Acquired HIV Have Preserved Lung Function at School Age

Attia, Engi F., Moraa, Hellen, Maleche-Obimbo, Elizabeth, Wamalwa, Dalton, Gómez, Laurén A., Rylance, Sarah, Vundla, Rumbidzayi, Ferrand, Rashida A., Karr, Catherine J., John-Stewart, Grace C. and Benki-Nugent, Sarah F. (2022) 'Most Early-Treated Children With Perinatally Acquired HIV Have Preserved Lung Function at School Age'. JAIDS: Journal of Acquired Immune Deficiency Syndromes, Vol 89, Issue 1, pp. 69-76.

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Abstract

Background:
Impaired lung function is common among older children with perinatally acquired HIV (PHIV) who initiated antiretroviral therapy (ART) late in childhood. We determined the prevalence of abnormal spirometry and cofactors for impaired lung function among school-age children with PHIV who initiated ART when aged 12 months or younger.

Setting:
Children who received early ART in the Optimizing Pediatric HIV-1 Therapy study in Kenya and underwent spirometry at school age.

Methods:
Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were measured. Abnormal spirometry was defined as follows: obstructive (FEV1/FVC <1.64 z score [zFEV1/FVC]) and restricted (zFVC <1.64 with zFEV1/FVC ≥1.64). Characteristics, including anthropometric and HIV-related data, were ascertained in infancy and at school age. Caregiver carbon monoxide exposure served as a proxy for school-age child exposure. Linear regression determined associations of cofactors with lung function.

Results:
Among 40 children, the median age was 5 months at ART initiation and 8.5 years at spirometry. The mean zFEV1, zFVC, and zFEV1/FVC (SD) were 0.21 (1.35), 0.31 (1.22), and −0.24 (0.82), respectively. Five (13%) children had abnormal spirometry. Spirometry z scores were significantly lower among children with pre-ART pneumonia, WHO HIV stage 3/4, higher HIV RNA at 6 months after ART initiation, low anthropometric z scores, and higher carbon monoxide exposure.

Conclusions:
Most of the children with PHIV who initiated ART at age 12 months or younger had normal spirometry, suggesting that ART in infancy preserved lung function. However, 13% had abnormal spirometry despite early ART. Modifiable factors were associated with impaired lung function, providing potential targets for interventions to prevent chronic lung disease.

Item Type:	Article
Additional Information:	Parts of the data were presented at the 48th Union World Conference on Lung Health, Guadalajara, Mexico (October 11–14, 2017).
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 320 Child Welfare. Child Health Services. 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 280 Respiratory system
Faculty: Department:	Education
Digital Object Identifer (DOI):	https://doi.org/10.1097/QAI.0000000000002823
Depositing User:	Stacy Murtagh
Date Deposited:	14 Dec 2021 10:06
Last Modified:	23 Aug 2023 16:33
URI:	https://archive.lstmed.ac.uk/id/eprint/19634

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