Chronic lung disease in human immunodeficiency virus (HIV) infected children

Abstract

The development of chronic lung disease is common in HIV‐infected children. The spectrum of chronic HIV‐associated lung disease includes lymphocytic interstitial pneumonia (LIP), chronic infections, immune reconstitution inflammatory syndrome (IRIS), bronchiectasis, malignancies, and interstitial pneumonitis. Chronic lung disease may result from recurrent or persistent pneumonia due to bacterial, mycobacterial, viral, fungal or mixed infections. In high tuberculosis (TB) prevalence areas, M. tuberculosis is an important cause of chronic respiratory illness. With increasing availability of highly active antiretroviral therapy (HAART) for children in developing countries, a rise in the incidence of IRIS due to mycobacterial or other infections is being reported. Diagnosis of chronic lung disease is based on chronic symptoms and persistent chest X‐ray changes but definitive diagnosis can be difficult as clinical and radiological findings may be non‐specific. Distinguishing LIP from miliary TB remains a difficult challenge in HIV‐infected children living in high TB prevalence areas. Treatment includes therapy for specific infections, pulmonary clearance techniques, corticosteroids for children with LIP who are hypoxic or who have airway compression from tuberculous nodes and HAART. Children who are taking TB therapy and HAART need adjustments in their drug regimes to minimize drug interactions and ensure efficacy. Preventative strategies include immunization, chemoprophylaxis, and micronutrient supplementation. Early use of HAART may prevent the development of chronic lung disease. Pediatr Pulmonol. 2008; 43:1–10. © 2007 Wiley‐Liss, Inc.

Burden of respiratory diseasw among paediatric patients infected with HIV

“…Although Zar (2008) discusses a shift from acute to chronic exacerbations of respiratory disease, this state is not clearly depicted in this study due to the young population age. This study may offer more insight into acute respiratory diseases.…”

“…The management of HIV has made progress in South Africa and therefore, the incidence of acute and opportunistic respiratory infections has declined while HIV associated chronic lung disease has increasingly emerged (Zar, 2008). The incidence of acute pneumonia is much higher in HIV infected than uninfected children (Madhi et al, 2000) and chronic lung diseases are much more common owing to a wider range of pulmonary diseases (Graham, 2005).…”

“…The CD4 count is a good immunological marker of disease progression. Thus, a CD4 count of more than 25% shows that there is amongst HIV infected children (Zar, 2008). Zar and Mulholland reported in 2003 that of more than one and a half million HIV infected children, 90% will develop a respiratory illness sometime in the course of their HIV condition.…”

Acute cor pulmonale due to lymphocytic interstitial pneumonia in a child with AIDS

“…Also, it is not known if other viruses such as Epstein barr virus associated with AiDs may be involved in its development. 7,18,19 Pitcher & Zar wrote a review of articles published between 1982 and 2007 about cases of LiP to compare diagnosis used to those with radiological criteria for presumptive diagnosis of LiP in children as defined by the centers for Disease control and Prevention, UsA. the inclusion criteria were children under 13 years, HiV infection, and radiological and pathological data such as lung biopsy and chest X-ray.…”

“…18 the differential diagnosis of LiP with other chronic lung diseases in HiV-infected children should be considered, as it is difficult to distinguish LiP from miliary tuberculosis in areas of high prevalence of tuberculosis. 19 Pediatrians must routinely include the investigation of HiV infection in children presenting with recurrent respiratory infections.…”