Increased risk of asthma and atopic dermatitis in perinatally HIV-infected children and adolescents

Abstract

The incidence of asthma and atopic dermatitis (AD) were evaluated in HIV-infected (n=451) compared to HIV-exposed (n=227) but uninfected (HEU) children and adolescents by abstraction from clinical charts. Asthma was more common in HIV-infected compared to HEU children by clinical diagnosis (25% vs. 20%, p = 0.101), by asthma medication use, (31% vs. 22%, p = 0.012), and by clinical diagnosis or both medication use, (34% vs. 25%, p = 0.012). HIV-infected children had a greater risk of asthma compared to HEU children (HR = 1.37, 95% CI: 1.01 to 1.86). AD was more common in HIV-infected than HEU children (20% vs. 12%, p = 0.009)) and children with AD were more likely to have asthma in both cohorts (41% vs. 29%, p = 0.010). HIV-infected children and adolescents in this study had a 30% increased incidence of asthma and AD, a finding critical for millions of HIV-infected children worldwide.

HLA-DRB1454 and predictors of new-onset asthma in HIV-infected Thai children

“…In fact, the incidence of asthma in the immediate-arm (26.5%) exceeded those that were seen in healthy Thai children (18%) [7]. Together with other reports [1,2], these data support the contribution of immune reconstitution on the development of asthma following ART initiation. Low household income and HLADRB1454 were also predictive of asthma.…”

“…Recent cohort studies have demonstrated a rise in asthma incidence following antiretroviral therapy (ART) in US children living with HIV [1][2][3], possibly due to immune reconstitution [2]. As the extent of immune reconstitution can be affected by the pre-ART CD4 level, we assessed new onset asthma in a randomized study of children who initiated ART at different CD4 levels in the Pediatric Randomized Early versus Deferred Initiation in Cambodia and Thailand study (The PREDICT study) [4].…”

“…Diagnosis of asthma was defined as asthma medication use after age ≥ 3 years (e.g. bronchodilators, and inhaled corticosteroids) [1]. The data were censored at the time of randomization and asthma incidence was reported thereafter.…”

“…Fourteen were excluded for previously diagnosed asthma (11) and chronic lung disease [1] before enrollment, loss to follow-up at week 0 [1] and ART use prior to entry [1]. All children were perinatally HIV-infected with a baseline median (IQR) age of 7.5 (4.8-9.0) years, and 62% were female.…”

Atopic Dermatitis: Update on Pathogenesis and Comorbidities

“…In contrast, some infections might play a pathogenic role in AD. A study of 451 human immunodeficiency virus (HIV)-infected children and 227 HIV-exposed but uninfected children and adolescents found that AD was significantly more common in HIV-infected children (20 % vs. 12 %) [20]. A cross-sectional study of 306 Ethiopian children age 1-5 years found that history of malaria, infection with the intestinal parasite Trichuris, and use of piped water as opposed to river water were all associated with increased risk of AD [21].…”