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

Nair, Arjun; Rylance, Jamie; Mujuru, Hilda; Nathoo, Kusum; McHugh, Grace; Majonga, Edith; Metcalfe, John; Kranzer, Katharina; Ferrand, Rashida A

doi:10.1093/cid/cix778

Cited by 46 publications

(80 citation statements)

References 33 publications

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“…Expiratory views confirmed air trapping in more than 90% of cases in whom expiratory imaging was performed, consistent with a diagnosis of bronchiolitis obliterans (BO). These findings are similar to those described in two cohorts of HIV‐infected children in Zimbabwe in which decreased attenuation was the more common finding, although the prevalence of mosaic attenuation was lower at 43% and 55% . Differences in patient selection, with higher numbers of documented previous TB (71% in our cohort compared with 36%) or prior hospitalization for pneumonia (35% compared with 16%) may explain these differences.…”

Section: Discussionsupporting

confidence: 88%

“…In patients with bronchiectasis, associated mosaic attenuation occurred in almost all (95%). The extent of bronchiectasis correlated strongly with the extent of decreased attenuation, again supporting the likelihood of small airways disease preceding bronchiectasis . TB has been reported as an important etiology for the development of BO in endemic regions in HIV‐negative patients .…”

Section: Discussionmentioning

confidence: 58%

“…A recent study reported that pulmonary nodules frequently occurred in healthy children; thus these findings may be consistent with the occurrence of incidental nodules . Lymphocytic interstitial pneumonitis (LIP) was formerly an important cause of nodules in HIV‐infected children before cART but is no longer commonly seen due to use of cART …”

Section: Discussionmentioning

confidence: 62%

“…Chronic sequelae of HIV, including chronic lung disease are therefore increasingly emerging . There are very limited data that describe the radiological spectrum of such disease with only two studies of high‐resolution computed tomography (HRCT) imaging in adolescents . In both, ring and tram opacities were the most prevalent findings on CXR, consistent with chronic lung disease manifesting as bronchiectasis.…”

Section: Introductionmentioning

confidence: 99%

“…In one study of 56 children, HRCT showed predominantly small airway disease, specifically bronchiolitis obliterans, followed by bronchiectasis . The more recent study reported that mosaic attenuation or bronchiectasis was the most common HRCT findings in a combined pediatric and adolescent population of 84 HIV‐infected patients on cART …”

Section: Introductionmentioning

confidence: 99%

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High‐resolution computed tomography features of lung disease in perinatally HIV‐infected adolescents on combined antiretroviral therapy

Plessis

Andronikou

Machemedze³

et al. 2019

Pediatric Pulmonology

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Introduction Chronic lung disease is common in perinatally HIV‐infected children as they increasingly surviving into adolescence. There are few data on the radiologic spectrum of disease in this population. Methods Contrasted high‐resolution computed tomography (HRCT) was performed in ambulatory South African adolescents enrolled in a prospective study of perinatally‐infected adolescents aged 9 to 14 years established on combined antiretroviral therapy (cART) and followed for 36 months. Consecutive participants with reduced lung function (defined by a forced expiratory volume in 1 second [FEV1] of <80% normal and/or lung diffusion capacity [DLCO] <80% normal] underwent HRCT. History, clinical, and laboratory data were collected. Two radiologists blinded to clinical data and to each other, reported scans using standardized methodology; a third radiologist resolved discrepancies. Results Amongst 100 participants undergoing HRCT, median age was 13.8 years (12.8‐15.1). The median duration on cART was 8.4 years (IQR = 5.7‐9.8). Mosaic attenuation was the most common finding (73%). Of these 71 (91%) demonstrated associated air trapping radiologically consistent with bronchiolitis obliterans. Bronchiectasis occurred in 39% with significant correlation between extent of bronchiectasis and mosaic attenuation (r = 0.57, P < .001). Prior hospitaliszation for childhood pneumonia at any time before enrollment was associated with mosaic attenuation (OR = 3.9, 95%CI, [1.2‐12.5]); prior pulmonary tuberculosis (TB) was associated with the combination of mosaic attenuation and bronchiectasis (OR = 4.9, 95%CI, [1.6‐15.7]). Most participants (86%) with mosaic attenuation had stage III or IV HIV disease at time of HIV diagnosis (OR = 3.6; [0.9‐14.9]). Inter observer agreement between the two readers was good for bronchiectasis (K = 0.71) and moderate for mosaic attenuation (K = 0.51). Discussion Despite well‐controlled HIV and long duration of cART, HRCT changes were common in perinatally HIV‐infected adolescents. There was a high prevalence of small airways disease with and without associated bronchiectasis. These changes were associated with prior pulmonary TB or prior severe pneumonia. Strategies to prevent and treat early life respiratory infection must be strengthened to reduce the burden of chronic lung disease in HIV‐infected adolescents.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High‐resolution computed tomography features of lung disease in perinatally HIV‐infected adolescents on combined antiretroviral therapy

Plessis

Andronikou

Machemedze³

et al. 2019

Pediatric Pulmonology

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Effect of Once-Weekly Azithromycin vs Placebo in Children With HIV-Associated Chronic Lung Disease

et al. 2020

Self Cite

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Key Points Question What is the effect of weekly azithromycin on morbidity in children with HIV-associated chronic lung disease? Findings In this randomized clinical trial that included 347 children aged 6 to 19 years, azithromycin did not improve lung function. The rate of acute respiratory exacerbations was 12.1 events per 100 person-years in the azithromycin group and 24.7 events per 100 person-years in the control group; the hospitalization rate was 1.3 events per 100 person-years in the azithromycin group and 7.1 events per 100 person-years in the placebo group. Meaning These findings suggest that prophylactic azithromycin has no effect on lung function in children with HIV-associated chronic lung disease but it is associated with a lower rate of acute respiratory exacerbations.

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An interprofessional model of care for adolescents with perinatal HIV: A qualitative study

Comley‐White,

Ntsiea,

Potterton

2024

Health Science Reports

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Background and AimsThe number of perinatally HIV‐infected adolescents (PHIVA) is increasing however many health care systems are not prepared for this population and their health challenges, specifically a model of care (MoC) is lacking. Thus the objective of this study was to develop and propose a MoC for PHIVA.MethodsThrough a qualitative study design, a MoC was developed and ratified with two focus groups, consisting of PHIVA and healthcare professionals.ResultsSeven participants were included in each focus group and the following themes were developed: relatable attributes; missing components; implementation and suggestions. Changes were made to the drafts of the MoC in response to the focus group results, leading to the finalisation of a MoC for PHIVA. The MoC focused on the importance of interprofessional health care and addressed the physical sequelae that PHIVA are likely to encounter. A schematic of the MoC was created for the use in general public education.ConclusionIt is important that healthcare facilities are equipped to handle the specific needs of PHIVA. The interprofessional MoC developed in this study helps to address the requirements of this population.

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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

Cited by 46 publications

References 33 publications

High‐resolution computed tomography features of lung disease in perinatally HIV‐infected adolescents on combined antiretroviral therapy

High‐resolution computed tomography features of lung disease in perinatally HIV‐infected adolescents on combined antiretroviral therapy

Effect of Once-Weekly Azithromycin vs Placebo in Children With HIV-Associated Chronic Lung Disease

An interprofessional model of care for adolescents with perinatal HIV: A qualitative study

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