Chest radiographic abnormalities in HIV-infected African children: a longitudinal study

Pitcher, R; Lombard, Carl; Cotton, Mark F.; Beningfield, Steve; Workman, Lesley; Zar, Heather J.

doi:10.1136/thoraxjnl-2014-206105

Cited by 15 publications

(11 citation statements)

References 24 publications

(14 reference statements)

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“…In low-income settings where pulmonary diagnostics such as high resolution computed tomography and lung function testing are not readily available, these symptoms often result in misdiagnosis of tuberculosis and unnecessary empirical tuberculosis treatment, particularly in children and adolescents, who tend to have chronic, non-specific abnormalities on chest radiography. 73,74 If not already on ART, any adolescent with HIV diagnosed with tuberculosis should be started on ART as soon as is practically possible, following the start of tuberculosis treatment. 75 It is common to wait a short period of time to allow the individual to become accustomed to tuberculosis treatment before starting ART, but this should not usually be more than a couple of weeks.…”

Section: Tuberculosis Disease Remains the Main Cause Of Mortality Amomentioning

confidence: 99%

Adolescent tuberculosis

Snow

Cruz

Seddon

et al. 2020

The Lancet Child & Adolescent Health

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Adolescence is characterised by a dramatic increase in the incidence of tuberculosis, a fact that has been appreciated since the early 20 th century. The majority of the world's adolescents live in low and middle-income countries where tuberculosis remains common, and where they comprise one quarter of the population. Despite this, adolescents have not yet been addressed as a distinct population in tuberculosis policy or within tuberculosis treatment services, and emerging evidence suggests that current models of care do not meet their needs.This article reviews current knowledge about tuberculosis in adolescence with a focus on the management of infection and disease, including HIV co-infection and rifampicin-resistant tuberculosis. Recent progress in vaccine development is outlined and important directions for future research are highlighted. Search strategy and selection criteriaThis was a narrative review of the literature on adolescent tuberculosis, informed by expert opinion and clinical experience. We reviewed the English-and Spanish-language literature for studies on adolescent tuberculosis to identify case series documenting clinical presentation and treatment outcomes. We searched PubMed with the following string on 19August 2019: ('tuberculosis'[Title]) AND ('adolescent'[TIAB]). The search returned 210 results, of which 11 were eligible for inclusion (Table 1), and we identified three additional studies from reference lists, for a total of 14 studies. Studies reporting solely on prevalence or where data from adolescents was aggregated with those of younger children or adults were excluded. Data were extracted regarding major site(s) of disease, percent of adolescents with microbiologic confirmation, adverse drug reactions, and final treatment outcomes.

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Section: Tuberculosis Disease Remains the Main Cause Of Mortality Amomentioning

confidence: 99%

Adolescent tuberculosis

Snow

Cruz

Seddon

et al. 2020

The Lancet Child & Adolescent Health

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“…13 Current CD4 may reflect immunosuppression that has persisted for weeks, months or years. Longstanding HIV infection in children during critical periods of immune system and organ development may influence organ injury and increase risk of chronic lung diseases of the parenchyma, airways and vasculature, 2,3,7,14 potentially impairing gas exchange. 5 Concurrently, pulmonary infections may trigger local inflammation and resultant destructive lung lesions.…”

Section: Discussionmentioning

confidence: 99%

“…1 Further, ART initiation at advanced HIV or lower CD4 may attenuate this observed risk reduction, as immune function defects and pulmonary parenchymal damage may not be completely reversible. 3,14 The association of ART with tachypnea suggests that immune modulation and pulmonary infection mitigation by ART has important implications for pulmonary pathophysiology, underscoring potential benefits of early, universal ART.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Hypoxia and Tachypnea Among Adolescents With Vertically-acquired HIV in Nairobi

Attia

Weiss

Obimbo

et al. 2017

Pediatric Infectious Disease Journal

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Background Chronic lung diseases are increasingly recognized complications of vertically-acquired HIV among adolescents in sub-Saharan Africa and may manifest with hypoxia or tachypnea. We sought to determine the prevalence of and risk factors for hypoxia and tachypnea among adolescents with vertically-acquired HIV in Nairobi, Kenya. Methods We performed a cross-sectional analysis of 258 adolescents with vertically-acquired HIV who were initiating care at the Coptic Hope Center for Infectious Diseases. Adolescents with documented pneumonia were excluded. Hypoxia was defined as resting oxygen saturation ≤92%, and tachypnea was based on the 99th percentile of age-appropriate respiratory rates. Logistic regression models adjusted for demographics and HIV severity estimated odds ratios (ORs) for risk of hypoxia and tachypnea associated with potential risk factors. Results Overall, 11% of adolescents had hypoxia and 55% had tachypnea. Advanced HIV (adjusted OR [aOR] 2.41) and low CD4 (aOR 1.74) were associated with greater hypoxia risk, but confidence intervals (CI) were wide and included the null (95% CI 0.93–6.23 and 0.69–4.39, respectively). Low CD4 (aOR 2.45, 95% CI 1.39–4.32), current ART use (aOR 0.48, 95% CI 0.27–0.86) and stunted growth (aOR 3.46, 95% CI 1.94–6.18) were associated with altered tachypnea risk. Conclusions Hypoxia and tachypnea are common among adolescents with vertically-acquired HIV. There was a suggestion that advanced HIV and low CD4 were associated with greater hypoxia risk. Low CD4, lack of ART use and stunted growth are risk factors for tachypnea. Our findings highlight the chronic lung disease burden in this population and may inform diagnostic algorithms.

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“…To our knowledge, there are no reports of HIV-associated cOB among adolescents in high-income settings, although the findings by Shearer and colleagues could partly be explained by small airways disease [19*]. Due to the cross-sectional nature of these data, however, it is not possible to determine whether findings reflect abnormalities persisting from insults during childhood or recent-onset disease [28*]. …”

Section: Spectrum Of Chronic Lung Diseasementioning

confidence: 99%

Bronchiectasis and other chronic lung diseases in adolescents living with HIV

Attia

Miller

Ferrand

2017

Current Opinion in Infectious Diseases

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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.

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Chest radiographic abnormalities in HIV-infected African children: a longitudinal study

Cited by 15 publications

References 24 publications

Adolescent tuberculosis

Adolescent tuberculosis

Risk Factors for Hypoxia and Tachypnea Among Adolescents With Vertically-acquired HIV in Nairobi

Bronchiectasis and other chronic lung diseases in adolescents living with HIV

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