Chest radiography patterns in 75 adolescents with vertically-acquired human immunodeficiency virus (HIV) infection

Abstract

AimTo evaluate lung disease on chest radiography (CR), the relative frequency of CR abnormalities, and their clinical correlates in adolescents with vertically-acquired human immunodeficiency virus (HIV) infection.Materials and methodsCRs of 75 patients [59 inpatients (33 males; mean age 13.7 ± 2.3 years) and 16 outpatients (eight males; mean age 14.1 ± 2.1 years)] were retrospectively reviewed by three independent observers. The overall extent of disease (to the nearest 5%), its distribution, and the proportional extents (totalling 100%) of different radiographic patterns (including ring/tramline opacities and consolidation) were quantified. CR features and clinical data were compared.ResultsCRs were abnormal in 51/75 (68%) with “extensive” disease in 38/51 (74%). Ring/tramline opacities and consolidation predominated (i.e., proportional extent >50%) in 26 and 21 patients, respectively. Consolidation was significantly more common in patients hospitalized primarily for a respiratory illness than patients hospitalized for a non-respiratory illness or in outpatients (p < 0.005, χ2 for trend); by contrast, ring/tramline opacities did not differ in prevalence across the groups. On stepwise logistic regression, predominant consolidation was associated with progressive dyspnoea [odds ratio (OR) 5.60; 95% confidence intervals (CI): 1.60, 20.1; p < 0.01] and was associated with a primary respiratory cause for hospital admission (OR: 22.0; CI: 2.7, 181.1; p < 0.005). Ring/tramline opacities were equally prevalent in patients with and without chronic symptoms and in those admitted to hospital with respiratory and non-respiratory illness.ConclusionIn HIV-infected adolescents, evaluated in secondary practice, CR abnormalities are prevalent. The presence of ring/tramline opacities, believed to reflect chronic airway disease, is not linked chronic respiratory symptoms.

Evidence of improving antiretroviral therapy treatment delays: an analysis of eight years of programmatic outcomes in Blantyre, Malawi

“…Adolescents were significantly more likely to initiate ART with advanced HIV infection than individuals in other age groups. This supports data from Zimbabwe showing that HIV-infected adolescents are a neglected group, with high rates of undiagnosed HIV [26], late presentation for care with high a prevalence of chronic complications [27,28] and numerous socio-economic complications, including an extremely high rate of orphanhood of 73% [28] and emotional and psychological difficulties. We were reassured to find that, on adjusted analysis, adolescents and young adults did not have a higher risk of ART treatment delay, and this may be due to the availability of teen groups and integrated family clinics at QECH supporting access to care.…”

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

“…The latter has been described in a previous study from Zimbabwe. It seems to represent, as in non-HIV-related obliterative bronchiolitis, a final common pathway of lung injury typified radiologically by air trapping and mosaic attenuation of the lung parenchyma [2,9]. The features on plain chest radiography are subtle and nonspecific, and high-resolution computed tomography is the definitive imaging modality.…”

“…In these studies, even participants with pronounced respiratory impairment looked well at rest, not all had cough, and plain radiological abnormalities were subtle and not consistent with LIP [9]. However, these studies did not include HIV-uninfected controls and included a mix of children who were ART-naive as well as those taking ART.…”

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

“…Principal chest radiographic and HRCT patterns were defined according to the Fleischner Society Glossary of terms [ 13 ]. Chest radiographic abnormalities were quantified using a previously validated scoring system with low interobserver variability [ 14 ]. In brief, the overall extent of abnormal lung (irrespective of pattern) was graded semiquantitatively on a 5-point scale (0, normal lung; 1–4, 1%–25%, 26%–50%, 51%–75%, and 76%–100% abnormal lung, respectively).…”