Chronic Morbidity Among Older Children and Adolescents at Diagnosis of HIV Infection

Abstract

Background:Substantial numbers of children with HIV present to health care services in older childhood and adolescence, previously undiagnosed. These “slow-progressors” may experience considerable chronic ill health, which is not well characterized. We investigated the prevalence of chronic morbidity among children aged 6–15 years at diagnosis of HIV infection.Methods:A cross-sectional study was performed at 7 primary care clinics in Harare, Zimbabwe. Children aged 6–15 years who tested HIV positive following provider-initiated HIV testing and counseling were recruited. A detailed clinical history and standardized clinical examination was undertaken. The association between chronic disease and CD4 count was investigated using multivariate logistic regression.Results:Of the 385 participants recruited [52% female, median age 11 years (interquartile range 8–13)], 95% were perinatally HIV infected. The median CD4 count was 375 (interquartile range 215–599) cells per cubic millimeter. Although 78% had previous contact with health care services, HIV testing had not been performed. There was a high burden of chronic morbidity: 23% were stunted, 21% had pubertal delay, 25% had chronic skin disease, 54% had a chronic cough of more than 1 month-duration, 28% had abnormal lung function, and 12% reported hearing impairment. There was no association between CD4 count of <500 cells per cubic millimeter or <350 cells per cubic millimeter with WHO stage or these chronic conditions.Conclusions:In children with slow-progressing HIV, there is a substantial burden of chronic morbidity even when CD4 count is relatively preserved. Timely HIV testing and prompt antiretroviral therapy initiation are urgently needed to prevent development of chronic complications.

Bronchiectasis and other chronic lung diseases in adolescents living with HIV

“…Over half of older children and adolescents reported at least one chronic respiratory symptom in recent studies from Zimbabwe, Malawi and Kenya [8*,10*,11*,12*,13*,14*]. Chronic cough and sputum production were reported by 21–60% and breathlessness by 12–18%, but wheezing was uncommon [8*,10*,11*,12*,13*,14*,15*].…”

“…Over half of older children and adolescents reported at least one chronic respiratory symptom in recent studies from Zimbabwe, Malawi and Kenya [8*,10*,11*,12*,13*,14*]. Chronic cough and sputum production were reported by 21–60% and breathlessness by 12–18%, but wheezing was uncommon [8*,10*,11*,12*,13*,14*,15*]. The prevalence of tachypnoea is difficult to quantify as definitions vary between studies, but elevated respiratory rates are common [8*,9*,10*,11*, 15*].…”

“…Chronic cough and sputum production were reported by 21–60% and breathlessness by 12–18%, but wheezing was uncommon [8*,10*,11*,12*,13*,14*,15*]. The prevalence of tachypnoea is difficult to quantify as definitions vary between studies, but elevated respiratory rates are common [8*,9*,10*,11*, 15*]. Hypoxia after sub-maximal exercise was a striking finding among 12–38% [10*,11*,12*,13*,15*,16*].…”

“…In particular, adolescents with delayed diagnosis of perinatally-acquired HIV have a disproportionately high burden of chronic respiratory disease [8*,9*,10*,11*]. We review the spectrum of and risk factors for HIV-associated CLD among adolescents living with HIV, as well as considerations in diagnosis and management.…”

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

“…Nevertheless, recent studies in Southern Africa have demonstrated that about 30% of African HIV-infected older children have chronic respiratory symptoms, classically a chronic cough [often leading to presumptive treatment for tuberculosis (TB)] and reduced exercise tolerance [3,4]. 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].…”