Forced Expiratory Flow in Uninfected Infants and Children Born to HIV-infected Mothers

Abstract

The Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV (P(2)C(2) HIV) Study is a multicenter study examining pulmonary and cardiac outcomes in offspring of HIV-infected mothers. This portion of the P(2)C(2) study tests the hypothesis that infants exposed to, but uninfected by, maternal HIV have normal maximal expiratory flow at functional residual capacity (V'max,(FRC)). We obtained 500 measurements of V'max,(FRC) by rapid thoracic compression in 285 children ages 6-30 mo in five U.S. centers. The data were compared with those from a healthy cohort of children described elsewhere. V'max,(FRC) rose with height in a linear relationship. The slope of the regression line in the exposed infants did not differ statistically from the slope in the comparison group, but the intercept was about 20% lower (p < 0.001). Height and weight were comparable in the two cohorts, and the differences between intercepts persisted after adjusting for birth weight and gestational age. However, maternal HIV infection cannot be assumed to be the cause as the cohorts may have differed in other variables, such as socioeconomic status and frequency of maternal smoking and drug use. Also, measurements varied substantially within and between our five centers, probably in part because of different racial and ethnic distributions. In summary, maternal HIV infection probably has only a modest effect, if any, on maximal expiratory flow at functional residual capacity in uninfected infants.

Respiratory Function in Healthy Taiwanese Infants: Tidal Breathing Analysis, Passive Mechanics, and Tidal Forced Expiration

“…Several results of VmaxFRC in healthy Caucasian infants have been published recently [ 10 , 27 , 28 ]. Our reference data of VmaxFRC are comparable with those reported by Hanrahan and Hoo; however, the values from our study were considerably higher than those reported by Colin ( Fig 4C ), possibly because of the distinct methodologies used for the tests.…”

“…Our reference data of VmaxFRC are comparable with those reported by Hanrahan and Hoo; however, the values from our study were considerably higher than those reported by Colin ( Fig 4C ), possibly because of the distinct methodologies used for the tests. The maximum pressure of the inflatable jacket used by Colin et al was only 10 kPa [ 28 ]; however, the jacket pressure that we used for examining infants older than 12 months often exceeded 10 kPa. In the study, the means (and 95% confidence intervals) of jacket pressure in different age group were as below: 5–9 mo, 8.7 (8.4–9.0) kPa; 10–15 mo, 10.6 (10.2–11.0) kPa; 16–21 mo, 11.7 (11.2-–12.2) kPa; 22–26 mo, 12.7 (11.6-–13.8) kPa.…”

Increased incidence of asthma in HIV-infected children treated with highly active antiretroviral therapy in the National Institutes of Health Women and Infants Transmission Study

“…37 There is some evidence in the pulmonary literature that HIV-exposed infants had a 20% lower partial forced expiratory flow as compared to historical controls. 38 Although the authors at that time discounted an HIV exposure factor as the basis for causation, in retrospect, this may well have played a role in producing this diminution of infant lung function.…”

Long-term pulmonary complications in perinatally HIV-infected youth

“…Inflammatory mediators and HIV drugs could cross the placenta, injure the developing lung and create diffuse chronic inflammation. The neonatal HEU group studied by Colin et al (42) demonstrated an unexpected mean 20% decrease in expiratory airflow in HEU neonates compared to age-matched neonatal controls supports the possibility that maternal factors may adversely affect the fetal lung. However, in the absence of a control group without exposure to maternal HIV in utero, we are unable to conclude from our data that HEU youth have a higher prevalence of fixed airway obstruction than normal adolescents or that they have a higher risk for lung disease in the future.…”