Long-term pulmonary complications in perinatally HIV-infected youth

Abstract

Background Increased incidence and prevalence of asthma have been documented for perinatally HIV-infected (HIV) youth 10–21 years of age (youth) compared to HIV-exposed uninfected (HEU) youth. Objective To perform objective pulmonary function tests (PFTs) in HIV and HEU youth with and without diagnosed asthma. Method Asthma was determined in 370 participants (218 HIV, 152 HEU) by chart review and self-report at 13 sites. Interpretable PFTs (188 HIV, 132 HEU) were classified as obstructive, restrictive, or normal and reversibility was determined after bronchodilator inhalation. HIV-1 RNA, CD4 and CD8 T-cells, eosinophils, total IgE, allergen-specific IgE, and urinary cotinine were measured. Adjusted prevalence ratios (aPR) of asthma and PFT outcomes were determined for HIV relative to HEU controlling for age, race/ethnicity and sex. Results Current asthma was identified in 75/218 (34%) HIV and 38/152 (25%) HEU (aPR=1.33, p=0.11). Prevalence of obstructive disease did not differ by HIV status. Reversibility was less likely in HIV youth than in HEU (17/183 (9%) vs. 21/126 (17%), (aPR=0.47, p=0.020) overall and among just those with OBS (aPR=0.46, p=0.016). Among HIV youth with current asthma, serum IgE levels were inversely correlated with CD8 T-cell, and positively correlated with eosinophil counts, and not associated with CD4 T-cells. HIV youth had lower association of specific IgE to several inhalant and food allergens compared to HEU and significantly lower CD4/CD8 T-cell ratios (suggesting immune imbalance). Conclusion Compared to HEU, HIV youth demonstrated decreased reversibility of obstructive lung disease, atypical of asthma. This may indicate an early stage of chronic obstructive pulmonary disease. Follow-up into adulthood is warranted to further define their pulmonary outcomes.

Adolescent age is an independent risk factor for abnormal spirometry among people living with HIV in Kenya

“…They frequently had abnormal CTs, with a predominance of mosaic attenuation that correlated with post-bronchodilator airflow limitation but not bronchodilator responsiveness. These findings together argue against asthma as a primary CLD etiology in this population, though asthma likely plays a role [11–13,15,22]. Although emphysema and bronchiectasis were rare, emphysema correlated with FEV 1 <LLN (an indicator of impaired airflow).…”

“…We considered spirometry as abnormal if any of these patterns was present pre-bronchodilator to allow comparison with studies that have not uniformly administered bronchodilators. Bronchodilator responsiveness was identified if post-bronchodilator FEV 1 or FVC increased 200 mL and 12% among adults and if FEV 1 increased >10% among adolescents [21,22].…”

NK cells in treated HIV-infected children display altered phenotype and function

“…14 HEU subjects were recruited from those enrolled in the Pediatric HIV/AIDS Cohort Study. 18 Inclusion criteria was MTCT for HIV-infected and perinatal exposure for HEU children.…”

“…We identified differences in NK-cell phenotype and function in both cohorts and could associate the phenotypic variation with markers of disease progression in HIV-infected patients. Given the prevalence of pulmonary complications in HIV-infected patients 18 and the role of NK cells in allergic asthma, 19 we also examined NK-cell phenotype on the basis of asthma incidence.…”

Noncommunicable diseases in adolescents with perinatally acquired HIV-1 infection in high-income and low-income settings

“…A common pathology contributing to CLD in perinatally-infected adolescents is small-airway bronchiectasis following repeated pneumonias (especially tuberculosis and lymphocytic interstitial pneumonitis) prior to immune reconstitution, resulting in permanent distortion of lung tissue by cicatrix (scarring) [91]. Th1 /Th2 imbalance may increase the risk of atypical asthma that is poorly-responsive to standard asthma therapies and may be a precursor to adult chronic obstructive pulmonary disease [92]. Obliterative bronchiolitis may be more common than previously recognized, present in 43% of ART-treated adolescents meeting a clinical case definition of chronic lung disease (defined as chronic cough for ≥1 month in the absence of tuberculosis; resting tachypnea or dyspnea; or desaturation with exercise)[93].…”