Bronchiectasis and other chronic lung diseases in adolescents living with HIV

Abstract

Purpose of review The incidence of pulmonary infections has declined dramatically with improved access to antiretroviral therapy (ART) and co-trimoxazole prophylaxis, but chronic lung disease (CLD) is an increasingly recognized but poorly understood complication in adolescents with perinatally-acquired HIV. Recent findings There is a high prevalence of chronic respiratory symptoms, abnormal spirometry and chest radiographic abnormalities among HIV-infected adolescents in sub-Saharan Africa, where 90% of the world’s HIV-infected children live. The incidence of lymphocytic interstitial pneumonitis, the most common cause of CLD in the pre-ART era, has declined with increased ART access. Small airways disease, particularly constrictive obliterative bronchiolitis and bronchiectasis are emerging as leading causes of CLD among HIV-infected adolescents in low- and middle-income countries. Asthma may be more common in high-income settings. Likely risk factors for CLD include recurrent pulmonary infections, air pollution, HIV-related immune dysfunction and untreated HIV infection, particularly during critical stages of lung development. Summary Globally, the importance of HIV-associated CLD as a cause of morbidity and mortality is increasing, especially as survival has improved dramatically with ART and growing numbers of children living with HIV enter adolescence. Further research is urgently needed to elucidate the natural history and pathogenesis of CLD, and to determine optimal screening, diagnostic and treatment strategies.

Clinical outcomes in children and adolescents initiating antiretroviral therapy in decentralized healthcare settings in Zimbabwe

“…The pathogenesis is poorly understood but is thought to be a sequela of chronic infections and/or HIV-mediated chronic inflammation. Once established chronic lung disease appears to be poorly responsive to ART, and children with recurrent respiratory tract infections may require further interventions such as additional prophylactic antibiotics or anti-inflammatory agents [36].…”

Efficacy of salmeterol and formoterol combination treatment in mice with chronic obstructive pulmonary disease

“…Currently, chronic lung diseases, including asthma and COPD, are a global medical treatment burden and this burden is increasing (27)(28)(29)(30)(31)(32). Statistics indicate that COPD is a major cause of morbidity and mortality worldwide (33).…”

High‐resolution computed tomography features of lung disease in perinatally HIV‐infected adolescents on combined antiretroviral therapy

“…Perinatally HIV‐infected children are surviving into adolescence due to early diagnosis of HIV and use of combination antiretroviral therapy (cART) . Chronic sequelae of HIV, including chronic lung disease are therefore increasingly emerging . There are very limited data that describe the radiological spectrum of such disease with only two studies of high‐resolution computed tomography (HRCT) imaging in adolescents .…”

“…1,2 Chronic sequelae of HIV, including chronic lung disease are therefore increasingly emerging. [3][4][5] There are very limited data that describe the radiological spectrum of such disease with only two studies of high-resolution computed tomography (HRCT) imaging in adolescents. 4,6 In both, ring and tram opacities were the most prevalent findings on CXR, consistent with chronic lung disease manifesting as bronchiectasis.…”