Small-airway disease and its reversibility in human immunodeficiency virus-infected children on highly active antiretroviral therapy

Abstract

BACKGROUND: Lung function abnormalities may occur in children with human immunodeficiency virus (HIV) infection. Small-airway disease (SAD) precedes abnormalities in forced expiratory volume in 1 s (FEV 1). OBJECTIVE: This study aims to assess the presence and reversibility of SAD in HIV-infected children using the Global Lung Function Initiative standards. METHODS: A cross-sectional study was conducted over 6 months at the Paediatric HIV Clinic of the University of Nigeria Teaching Hospital in Enugu, Southeast Nigeria. Eligible consenting children with HIV infection were recruited. Lung function was measured, and the reversibility of FEV1 and forced vital capacity (FVC) was assessed at 12% while that of forced expiratory flow between 25% and 75% (FEF25-75) was assessed at 12%, 15%, and 20%. Predictors of abnormal Z-score values were determined by multivariate linear and logistic regressions. Statistically significant values were set at P < 0.05. RESULTS: The mean Z-score for FEV1, FVC, and FEF25-75 was − 2.19, −1.86, and − 1.60, respectively. Most patients (73%) had abnormal FEV1, while 52% had abnormal FEF25-75. Significant changes in FEV1 (P = 0.001) and FEF25-75 (P < 0.001) occurred after the bronchodilator response (BDR) test. Of the children whose FEV1 showed positive BDR, 70.9% had low zFEV1; 50% had low zFEF25-75, while all had low FEV1. Nutritional status (Z-score for body mass index) was significantly associated with low FEV1. CONCLUSIONS: Abnormal FEF25-75 as a marker of SAD and FEV1 with a positive BDR are common in HIV-infected children. These lung function abnormalities justify long-term follow-up for these patients.

A scoping review of lung function in children and adolescents living with HIV in the era of antiretroviral treatment

“…Data regarding prevalence of abnormal spirometry results is summarised in Table 2. The prevalence of low FEV 1 was reported in five papers and ranged from 25.3% to 73% 5,6,10,11,23 . FEV 1 /FVC ratio was reported in 14 studies, 6,10–12,16–19,21–26 and the prevalence of low FEV 1 /FVC ranged from 3% to 26% prebronchodilator.…”

“…Twelve papers enrolled participants established on ART 6,10,14,15,18–25 and six papers enrolled participants regardless of their ART status with the percentage on ART ranging from 69% to 97% 5,11–13,26,28 . Three papers did not report ART prevalence 16,17,27 .…”

“…Ten papers reported the spirometry data after giving bronchodilator (Table 2). Three papers reported the prevalence of abnormal spirometry parameters post‐bronchodilator 10–12 . Seven papers reported the prevalence of a positive post‐bronchodilator response which ranged from 9% to 35.5% for CALHIV from baseline 16,18,23,25–28 …”

“…The eight papers all used Global Lung Function Initiative Standards 2012 to calculate z ‐score, including three papers using African–American option, 14,23,25 one paper using non‑Caucasian “other” option, 10 and four papers did not specify which option of the GLI reference data was used 15,17,20,26 . Eight studies reported FEV 1 z ‐scores, including seven reported mean zFEV 1 10,14,17,20,23,25,26 and two reported median zFEV 1 15,26 . Among those studies, the mean zFEV 1 ranged from −2.19 to −0.73 and median zFEV 1 ranged from −1.94 to −1.31.…”

“…16 The African studies reported study populations from South Africa (n = 6), Zimbabwe (n = 9), Malawi (n = 3), Kenya (n = 3), and Nigeria (n = 1). The 21 studies represent 12 distinct study cohorts-six manuscripts involved a distinct study cohort, 5,10,16,[26][27][28] whereas the remaining six study cohorts were analyzed and reported in more than one manuscript. The BREATHE trial was a multicountry trial conducted in Zimbabwe and Malawi, and the findings were reported in two manuscripts.…”