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

Abstract

Introduction Chronic lung disease is common in perinatally HIV‐infected children as they increasingly surviving into adolescence. There are few data on the radiologic spectrum of disease in this population. Methods Contrasted high‐resolution computed tomography (HRCT) was performed in ambulatory South African adolescents enrolled in a prospective study of perinatally‐infected adolescents aged 9 to 14 years established on combined antiretroviral therapy (cART) and followed for 36 months. Consecutive participants with reduced lung function (defined by a forced expiratory volume in 1 second [FEV1] of <80% normal and/or lung diffusion capacity [DLCO] <80% normal] underwent HRCT. History, clinical, and laboratory data were collected. Two radiologists blinded to clinical data and to each other, reported scans using standardized methodology; a third radiologist resolved discrepancies. Results Amongst 100 participants undergoing HRCT, median age was 13.8 years (12.8‐15.1). The median duration on cART was 8.4 years (IQR = 5.7‐9.8). Mosaic attenuation was the most common finding (73%). Of these 71 (91%) demonstrated associated air trapping radiologically consistent with bronchiolitis obliterans. Bronchiectasis occurred in 39% with significant correlation between extent of bronchiectasis and mosaic attenuation (r = 0.57, P < .001). Prior hospitaliszation for childhood pneumonia at any time before enrollment was associated with mosaic attenuation (OR = 3.9, 95%CI, [1.2‐12.5]); prior pulmonary tuberculosis (TB) was associated with the combination of mosaic attenuation and bronchiectasis (OR = 4.9, 95%CI, [1.6‐15.7]). Most participants (86%) with mosaic attenuation had stage III or IV HIV disease at time of HIV diagnosis (OR = 3.6; [0.9‐14.9]). Inter observer agreement between the two readers was good for bronchiectasis (K = 0.71) and moderate for mosaic attenuation (K = 0.51). Discussion Despite well‐controlled HIV and long duration of cART, HRCT changes were common in perinatally HIV‐infected adolescents. There was a high prevalence of small airways disease with and without associated bronchiectasis. These changes were associated with prior pulmonary TB or prior severe pneumonia. Strategies to prevent and treat early life respiratory infection must be strengthened to reduce the burden of chronic lung disease in HIV‐infected adolescents.

Prevalence and antimicrobial resistance profiles of respiratory microbial flora in African children with HIV-associated chronic lung disease

“…Finally, both Masekela [14] and Verwey [21] studies also included multiple samples from the same participantsanalysis did not adjust for multiple sampling from the same participant. (9) and MRC dyspnoea score (1). φ Number of years on ART (n = 167), ART regimen(n = 172), Ever treated for TB (n = 172), Ever repeated a grade (n = 169), MRC dyspnoea score (n = 172).…”

“…Hence, the high SP carriage in our settings might also be attributed to the lack of pneumococcal vaccination. (9) and MRC dyspnoea score (1). φ n = 99 for the number of years on ART, ever repeated a grade, MRC dyspnoea score.…”

“…The colonisation of the nasopharynx by multiple bacterial species may have important clinical (9) and MRC dyspnoea score (1). σ n = 41 and 42 for the number of years on ART and Ever repeated a grade respectively ξ n = 50 for the number of years on ART, ever treated for TB & ever repeated a grade.…”

“…Respiratory diseases, in particular, are responsible for more than 50% of all HIV-related mortality in sub-Saharan Africa [4]. Recent studies in Malawi [5], Zimbabwe [6][7][8] and South Africa [9] have estimated a 30% prevalence of chronic lung disease (CLD) among CLWH. The typical clinical picture is that of hypoxia, tachypnoea, chronic cough, reduced exercise tolerance and impaired lung function [6,10]; high resolution computed tomography findings are consistent with constrictive obliterative bronchiolitis [11].…”

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

“…3,6,7 Lung function is commonly impaired, with an obstructive irreversible pattern, and abnormalities are subtle on radiographs. 3,8,9 The predominant findings on computed tomography are mosaic decreased attenuation [9][10][11] consistent with constrictive obliterative bronchiolitis (OB). 12,13 No association has been observed between abnormal lung function and ART use or duration, and HCLD is therefore likely unresponsive to ART once established.…”