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

Rylance, Jamie; McHugh, Grace; Metcalfe, John; Mujuru, Hilda; Nathoo, Kusum; Wilmore, Stephanie; Rowland‐Jones, Sarah; Majonga, Edith; Kranzer, Katharina; Ferrand, Rashida A

doi:10.1097/qad.0000000000001249

Cited by 52 publications

(108 citation statements)

References 35 publications

(38 reference statements)

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“…Over half of older children and adolescents reported at least one chronic respiratory symptom in recent studies from Zimbabwe, Malawi and Kenya [8*,10*,11*,12*,13*,14*]. Chronic cough and sputum production were reported by 21–60% and breathlessness by 12–18%, but wheezing was uncommon [8*,10*,11*,12*,13*,14*,15*]. The prevalence of tachypnoea is difficult to quantify as definitions vary between studies, but elevated respiratory rates are common [8*,9*,10*,11*, 15*].…”

Section: Spectrum Of Chronic Lung Diseasementioning

confidence: 99%

“…Chronic cough and sputum production were reported by 21–60% and breathlessness by 12–18%, but wheezing was uncommon [8*,10*,11*,12*,13*,14*,15*]. The prevalence of tachypnoea is difficult to quantify as definitions vary between studies, but elevated respiratory rates are common [8*,9*,10*,11*, 15*]. Hypoxia after sub-maximal exercise was a striking finding among 12–38% [10*,11*,12*,13*,15*,16*].…”

Section: Spectrum Of Chronic Lung Diseasementioning

confidence: 99%

“…The prevalence of tachypnoea is difficult to quantify as definitions vary between studies, but elevated respiratory rates are common [8*,9*,10*,11*, 15*]. Hypoxia after sub-maximal exercise was a striking finding among 12–38% [10*,11*,12*,13*,15*,16*]. One-third of adolescents had abnormal spirometry: forced expiratory volume in one second (FEV 1 ) and forced vital capacity (FVC) were lower among those with HIV, compared to age-, sex-, race- and height-adjusted predicted values, and compared to HIV-uninfected controls [8*,15*,17].…”

Section: Spectrum Of Chronic Lung Diseasementioning

confidence: 99%

“…Hypoxia after sub-maximal exercise was a striking finding among 12–38% [10*,11*,12*,13*,15*,16*]. One-third of adolescents had abnormal spirometry: forced expiratory volume in one second (FEV 1 ) and forced vital capacity (FVC) were lower among those with HIV, compared to age-, sex-, race- and height-adjusted predicted values, and compared to HIV-uninfected controls [8*,15*,17]. While some studies documented a substantial prevalence of airflow obstruction [10*,11*,12*], others reported a prominence of a restricted pattern [11*,13*,14*]; there was little reversibility with bronchodilators.…”

Section: Spectrum Of Chronic Lung Diseasementioning

confidence: 99%

“…In a study that performed spirometry in 216 perinatally HIV-infected adolescents in the USA, only 30% of those with airflow obstruction had bronchodilator reversibility (overall, 9% of those with interpretable spirometry) [19*]. In Zimbabwe, 3–5% of older children and adolescents with perinatally-acquired HIV reported a history of asthma [13*,15*], similar to the prevalence estimated in the general African paediatric population [40]. Reversibility with bronchodilators was uncommon in African studies reporting airflow obstruction among HIV-infected adolescents, with the exception of one South African study in which 15% had reversibility [10*,11*,12*,13*,18**].…”

Section: Spectrum Of Chronic Lung Diseasementioning

confidence: 99%

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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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Section: Spectrum Of Chronic Lung Diseasementioning

confidence: 99%

Section: Spectrum Of Chronic Lung Diseasementioning

confidence: 99%

Section: Spectrum Of Chronic Lung Diseasementioning

confidence: 99%

Section: Spectrum Of Chronic Lung Diseasementioning

confidence: 99%

Section: Spectrum Of Chronic Lung Diseasementioning

confidence: 99%

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Bronchiectasis and other chronic lung diseases in adolescents living with HIV

Attia

Miller

Ferrand

2017

Current Opinion in Infectious Diseases

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Effect of Once-Weekly Azithromycin vs Placebo in Children With HIV-Associated Chronic Lung Disease

et al. 2020

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Key Points Question What is the effect of weekly azithromycin on morbidity in children with HIV-associated chronic lung disease? Findings In this randomized clinical trial that included 347 children aged 6 to 19 years, azithromycin did not improve lung function. The rate of acute respiratory exacerbations was 12.1 events per 100 person-years in the azithromycin group and 24.7 events per 100 person-years in the control group; the hospitalization rate was 1.3 events per 100 person-years in the azithromycin group and 7.1 events per 100 person-years in the placebo group. Meaning These findings suggest that prophylactic azithromycin has no effect on lung function in children with HIV-associated chronic lung disease but it is associated with a lower rate of acute respiratory exacerbations.

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High HIV and active tuberculosis prevalence and increased mortality risk in adults with symptoms of TB: a systematic review and meta‐analyses

et al. 2018

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Introduction HIV and tuberculosis (TB) remain leading causes of preventable death in low‐ and middle‐income countries (LMICs). The World Health Organization (WHO) recommends HIV testing for all individuals with TB symptoms, but implementation has been suboptimal. We conducted a systematic literature review and meta‐analyses to estimate HIV and TB prevalence, and short‐term (two to six months) mortality, among adults with TB symptoms at community‐ and facility level.MethodsWe searched Embase, Global Health and MEDLINE databases, and reviewed conference abstracts for studies reporting simultaneous HIV and TB screening of adults in LMICs published between January 2003 and December 2017. Meta‐analyses were performed to estimate prevalence of HIV, undiagnosed TB and mortality risk at different health system levels.ResultsSixty‐two studies including 260,792 symptomatic adults were identified, mostly from Africa and Asia. Median HIV prevalence was 19.2% (IQR: 8.3% to 40.4%) at community level, 55.7% (IQR: 20.9% to 71.2%) at primary care level and 80.7% (IQR: 73.8% to 84.6%) at hospital level. Median TB prevalence was 6.9% (IQR: 3.3% to 8.4%) at community, 20.5% (IQR: 11.7% to 46.4%) at primary care and 36.4% (IQR: 22.9% to 40.9%) at hospital level. Median short‐term mortality was 22.6% (IQR: 15.6% to 27.7%) among inpatients, 3.1% (IQR: 1.2% to 4.2%) at primary care and 1.6% (95% CI: 0.45 to 4.13, n = 1 study) at community level.ConclusionsAdults with TB symptoms have extremely high prevalence of HIV infection, even when identified through community surveys. TB prevalence and mortality increased substantially at primary care and inpatient level respectively. Strategies to expand symptom‐based TB screening combined with HIV and TB testing for all symptomatic individuals should be of the highest priority for both disease programmes in LMICs with generalized HIV epidemics. Interventions to reduce short‐term mortality are urgently needed.

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

Cited by 52 publications

References 35 publications

Bronchiectasis and other chronic lung diseases in adolescents living with HIV

Bronchiectasis and other chronic lung diseases in adolescents living with HIV

Effect of Once-Weekly Azithromycin vs Placebo in Children With HIV-Associated Chronic Lung Disease

High HIV and active tuberculosis prevalence and increased mortality risk in adults with symptoms of TB: a systematic review and meta‐analyses

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