Longitudinal Changes in Spirometry in South African Adolescents Perinatally Infected With Human Immunodeficiency Virus Who Are Receiving Antiretroviral Therapy

Abstract

Background Despite increased access to highly active antiretroviral therapy (HAART), lung disease remains common in human immunodeficiency virus (HIV)–infected (HIV+) adolescents. There is limited information on changes in lung function over time in perinatally HIV+ adolescents on HAART. The objective was to investigate the progression of spirometry findings over 2 years in HIV+ adolescents on HAART in a prospective cohort, the Cape Town Adolescent Antiretroviral Cohort (CTAAC). Methods HIV+ adolescents aged 9–14 years, with at least 6 months of HAART, and a comparator group of healthy HIV-uninfected (HIV–), age-matched controls were enrolled in CTAAC. Spirometry and bronchodilator testing were done at baseline, 12 months, and 24 months. Mixed-effect models were used to compute longitudinal changes in lung function. Results Five hundred fifteen HIV+ adolescents, mean age 12 (standard deviation [SD], 1.6) years, 50.4% male, and 110 HIV– adolescents, mean age 11.8 (SD, 1.8) years, 45.6% male, were tested at baseline; 477 (93%) HIV+ and 102 (93%) HIV– adolescents at 12 months; and 473 (92%) HIV+ and 97 (88%) HIV– adolescents at 24 months. Only 5.4% of the HIV+ adolescents had HIV viral load >10 000 copies/mL at baseline. Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were lower in the HIV+ compared to the HIV– adolescents and tracked with no deterioration or catch-up over 2 years. Previous pulmonary tuberculosis (PTB) or lower respiratory tract infection (LRTI) was significantly associated with reduced FEV1 and FVC (P < .05 for both). Conclusions HIV+ adolescents had lower lung function over 2 years than HIV– adolescents. This study highlights the need for lung function surveillance and prevention of LRTIs and PTB in HIV+ adolescents.

Quantifying the global number of tuberculosis survivors: a modelling study

“…22,23 Moreover, studies have found prior history of pulmonary tuberculosis or severe lower respiratory tract infection to be independently associated with worse lung function in adolescents. 24,25 It therefore follows that protecting lung growth and capacity early in life is critically important for outcomes later in life. In the context of tuberculosis this means improving prevention and early diagnosis in childhood.…”

Effect of azithromycin on incidence of acute respiratory exacerbations in children with HIV taking antiretroviral therapy and co-morbid chronic lung disease: a secondary analysis of the BREATHE trial

“…This result may also be related to previous AREs, and in turn possible baseline antibiotic resistance. A prospective cohort study from South Africa by Githinji et al found that amongst adolescents with HIV a lower FEV 1 score was associated with previous lower respiratory tract infections [17]. These individuals may hence have had more frequent treatment with previous courses of antibiotics, possibly increasing the presence of baseline antibiotic resistance, making prophylactic azithromycin less effective in this subgroup.…”

Shorter Granulocyte Telomeres Among Children and Adolescents With Perinatally Acquired Human Immunodeficiency Virus Infection and Chronic Lung Disease in Zimbabwe

“…It is possible that the observations of shorter TL among both cART-naive and cART-treated C-PHIV, although modest, may become more pronounced later in life when the cumulative burden of HIV/cART and other environmental factors such as exposures to household smoke and other particulate pollutants have taken effect. A recent study from South Africa reported persistently lower lung function over 2 years among cART-treated adolescents living with HIV compared with HIV-negative controls [ 34 ]. Here, longitudinal CLD data were not available but we observed an improvement in TL following cART initiation in cART-naive children, although it remained lower than in HIV-uninfected controls.…”