The challenge of chronic lung disease in HIV‐infected children and adolescents

Weber, Heinrich C.; Gie, Robert P.; Cotton, Mark F.

doi:10.7448/ias.16.1.18633

Cited by 32 publications

(25 citation statements)

References 36 publications

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“…50 The range of chronic lung disease seems to differ in adolescents compared with younger children. 51 In a study from Zimbabwe of 116 adolescents with HIV infection acquired perinatally, more than 30% of children had severe and disabling chronic respiratory symptoms; these findings were confirmed by those of a study from Malawi in 160 older children. 52 Unexpectedly, in the Zimbabwe study, high-resolution CT scanning showed predominantly small-airways disease consistent with constrictive obliterative bronchiolitis, with lymphocytic interstitial pneumonitis being an exceptional finding.…”

Section: Chronic Diseasementioning

confidence: 69%

“…29 Obliterative bronchiolitis, which occurs with graft-versus-host disease and after viral infections and exposure to chemical fumes, is a progressive life-threatening condition, and little is known about its natural history and pathogenesis in people with HIV infection or how it should be managed. 51,53 Chest radiographic findings are non-specific, and high-resolution CT—the gold standard diagnostic method—is not typically available in resource-limited settings. 53 Obliterative bronchiolitis has not been described before in US and European cohorts of HIV-infected adolescents.…”

Section: Chronic Diseasementioning

confidence: 99%

See 1 more Smart Citation

Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges

Lowenthal

Bakeera-Kitaka

Marukutira

et al. 2014

The Lancet Infectious Diseases

388

397

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Worldwide, more than three million children are infected with HIV, 90% of whom live in sub-Saharan Africa. As the HIV epidemic matures and antiretroviral treatment is scaled up, children with HIV are reaching adolescence in large numbers. The growing population of adolescents with perinatally acquired HIV infection living within this region presents not only unprecedented challenges but also opportunities to learn about the pathogenesis of HIV infection. In this Review, we discuss the changing epidemiology of paediatric HIV and the particular features of HIV infection in adolescents in sub-Saharan Africa. Longstanding HIV infection acquired when the immune system is not developed results in distinctive chronic clinical complications that cause severe morbidity. As well as dealing with chronic illness, HIV-infected adolescents have to confront psychosocial issues, maintain adherence to drugs, and learn to negotiate sexual relationships, while undergoing rapid physical and psychological development. Context-specific strategies for early identification of HIV infection in children and prompt linkage to care need to be developed. Clinical HIV care should integrate age-appropriate sexual and reproductive health and psychological, educational, and social services. Health-care workers will need to be trained to recognise and manage the needs of these young people so that the increasing numbers of children surviving to adolescence can access quality care beyond specialist services at low-level health-care facilities.

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Section: Chronic Diseasementioning

confidence: 69%

Section: Chronic Diseasementioning

confidence: 99%

Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges

Lowenthal

Bakeera-Kitaka

Marukutira

et al. 2014

The Lancet Infectious Diseases

388

397

View full text Add to dashboard Cite

show abstract

“…Although corticosteroids are often available at a district hospital for children with LIP showing severe dyspnea, cyanosis, or hypoxia, this is often not the routine practice when the diagnosis is unclear or when clinicians are not experienced in managing clinical complications in children [81,82]. LIP has been shown to respond well to ART, but remains an important clinical consideration, especially in settings with low coverage of ART for HIV-infected children [83]. …”

Section: Health Systems Gapsmentioning

confidence: 99%

Understanding the contribution of common childhood illnesses and opportunistic infections to morbidity and mortality in children living with HIV in resource-limited settings

Modi¹,

Chiu²,

Ngeno³

et al. 2013

Aids

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Objective Although antiretroviral treatment (ART) has reduced the incidence of HIV-related opportunistic infections among children living with HIV, access to ART remains limited for children, especially in resource-limited settings. This paper reviews current knowledge on the contribution of opportunistic infections and common childhood illnesses to morbidity and mortality in children living with HIV, highlights interventions known to improve the health of children, and identifies research gaps for further exploration. Design and Methods Literature review of peer-reviewed articles and abstracts combined with expert opinion and operational experience. Results Morbidity and mortality due to opportunistic infections has decreased in both developed and resource-limited countries. However, the burden of HIV-related infections remains high, especially in sub-Saharan Africa, where the majority of HIV-infected children live. Limitations in diagnostic capacity in resource-limited settings have resulted in a relative paucity of data on opportunistic infections in children. Additionally, the reliance on clinical diagnosis means that opportunistic infections are often confused with common childhood illnesses which also contribute to excess morbidity and mortality in these children. Although several preventive interventions have been shown to decrease opportunistic infection-related mortality, implementation of many of these interventions remains inconsistent. Conclusions In order to reduce opportunistic infection-related mortality, early ART must be expanded, training for front-line clinicians must be improved, and additional research is needed to improve screening and diagnostic algorithms.

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“…Respiratory disease is the most common manifestation of HIV/AIDS among children, accounting for more than 50% of HIV-associated mortality [1–4]. The use of antiretroviral therapy (ART) and co-trimoxazole prophylaxis has contributed to a reduction in the rate of acute respiratory tract infections and mortality among HIV-infected children in both high-resource and low-resource settings [5].…”

Section: Introductionmentioning

confidence: 99%

Chronic lung disease in HIV-infected children established on antiretroviral therapy

Rylance

McHugh

Metcalfe

et al. 2016

Aids

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Objective:Respiratory disease is a major cause of morbidity and mortality in HIV-infected children. Despite antiretroviral therapy (ART), children suffer chronic symptoms. We investigated symptom prevalence, lung function and exercise capacity among older children established on ART and an age-matched HIV-uninfected group.Design:A cross-sectional study in Zimbabwe of HIV-infected children aged 6–16 years receiving ART for over 6 months and HIV-uninfected children attending primary health clinics from the same area.Methods:Standardized questionnaire, spirometry, incremental shuttle walk testing, CD4+ cell count, HIV viral load and sputum culture for tuberculosis were performed.Results:A total of 202 HIV-infected and 150 uninfected participants (median age 11.1 years in each group) were recruited. Median age at HIV diagnosis and ART initiation was 5.5 (interquartile range 2.8–7.5) and 6.1 (interquartile range 3.6–8.4) years, respectively. Median CD4+ cell count was 726 cells/μl, and 79% had HIV viral load less than 400 copies/ml. Chronic respiratory symptoms were rare in HIV-uninfected children [n = 1 (0.7%)], but common in HIV-infected participants [51 (25%)], especially cough [30 (15%)] and dyspnoea [30 (15%)]. HIV-infected participants were more commonly previously treated for tuberculosis [76 (38%) vs 1 (0.7%), P < 0.001], had lower exercise capacity (mean incremental shuttle walk testing distance 771 vs 889 m, respectively, P < 0.001) and more frequently abnormal spirometry [43 (24.3%) vs 15 (11.5%), P = 0.003] compared with HIV-uninfected participants. HIV diagnosis at an older age was associated with lung function abnormality (P = 0.025). No participant tested positive for Mycobacterium tuberculosis.Conclusion:In children, despite ART, HIV is associated with significant respiratory symptoms and functional impairment. Understanding pathogenesis is key, as new treatment strategies are urgently required.

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The challenge of chronic lung disease in HIV‐infected children and adolescents

Cited by 32 publications

References 36 publications

Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges

Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges

Understanding the contribution of common childhood illnesses and opportunistic infections to morbidity and mortality in children living with HIV in resource-limited settings

Chronic lung disease in HIV-infected children established on antiretroviral therapy

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