Reduced frequency of wheezing respiratory illness in infants with perinatal human immunodeficiency virus‐type 1 infection: A model for immunologic and inflammatory mechanisms of airway obstruction?

Abstract

A multivariate analysis using a logistic regression model evaluated odds ratio (OR) and 95% confidence limits (95% CL) of pediatrician-diagnosed wheezing respiratory illness in 75 infants with perinatal human immunodeficiency virus-type 1 (HIV-1) infection, 205 uninfected infants of HIV-1 infected mothers, and 1780 infants of HIV-1 uninfected mothers. Infants were prospectively followed-up for the first 2 years of life. Covariates were risk factors for wheezing respiratory illness (preterm delivery, low birth weight, maternal smoking, formula feeding, and neonatal respiratory disorders). Maternal use of illicit drugs in pregnancy, antiretroviral treatment in pregnancy, maternal HIV-1-related clinical condition at the time of delivery were also included in the models when infants of HIV-1 infected mothers were taken into account. Although the frequency of risk factors for wheezing respiratory illness was higher in infants of HIV-1 infected than in those of uninfected mothers, HIV-1 infection emerged as a protective factor [OR: 0.001 (95% CL: 0.0001-0.01); p < 0.001]. The frequency of risk factors was similarly high among infants of infected mothers, but OR was lower in HIV-1 infected than in uninfected infants of infected mothers (0.005; 95% CL: 0.0004-0.06; p < 0.001). Finally, OR was higher in uninfected infants of HIV-1 infected mothers (who evidenced a higher frequency of risk factors) than in infants of HIV-1 uninfected mothers (9.97; 95% CL: 4.87-20.40; p < 0.001). Understanding the reason why HIV-1 protects against wheezing respiratory illness could shed light on the immunologic and inflammatory mechanisms of airway obstruction.

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

“…<100 cells/μL in adults), but regain that potential with a return of CD4 + T cells upon treatment with HAART. This inverse correlation between the development of asthma and the degree of HIV-induced immunosuppression pattern underlines the important role of cellular immunity in airway hyperreactivity [15-17]. Evidence points to a generalized state of inflammation with HAART-induced immunoreconstitution or immunopreservation (i.e., HIV-infected infant treated with HAART before the loss of CD4 T cells) likely to involve the release of inflammatory cytokines, production of activated CD4 + and CD8 + T cells, and loss of T regulatory (T Reg ) cells and tolerance as the cause of pulmonary hyper-responsiveness.…”

Increased incidence of asthma in HIV-infected children treated with highly active antiretroviral therapy in the National Institutes of Health Women and Infants Transmission Study

“…Galli et al 12 reported a reduced frequency of wheezing (not defined as asthma) in infants with HIV infection who were followed for 2 years of life, but Foster et al 13 in a single-center retrospective study of 83 older children and young adults reported a several-fold increased asthma prevalence of 34 percent. 13 In the latter study, there was substantial evidence that antiretroviral medications either restored the CD4 + T cell count in children inadequately treated, or preserved the CD4 + T cell count in children adequately treated from birth.…”

Is There a Link between Wheezing in Early Childhood and Adverse Birth Outcomes? A Systematic Review

“…Four studies reported their results as odds ratios [28,29,31,32] one as relative risk ratio [25] and five as prevalence [24,26,30]. There were also some disparities in the definitions of adverse birth outcomes between studies.…”

“…Four studies examined wheezing at first year of life [24,26,30], four studies examined wheezing up to two years of life [25,27,29,31], one study examined wheezing up to five years old [32] and one included children with a mean age of 2.2 years old [28] (the last two studies remained in the review due to the fact that they also examined wheezing presence at the age of 2 years old).…”

“…Four studies measured the outcome as an odds ratio [28,29,31,32]. Galli et al [31] underlined an excess risk of wheezing presence for LBW infants (OR 11.88 95%CI 6.01–23.47) and Kumar et al [28] underlined the clear association of wheezing and both preterm and very preterm delivery (OR 1.7 95%CI 1.2–2.6 and OR 2.7 95%CI 1.3–5.5, respectively).…”