Impact of HIV and antiretroviral drug exposure on lung growth and function over 2 years in an African Birth Cohort

Abstract

Objective: To assess the impact of HIV and antiretroviral exposure without infection on lung growth and function over the first 2 years of life. Design: Prospective observational study of an African birth cohort, Drakenstein Child Health Study. Method: Infants enrolled antenatally had lung function measured at 6 weeks, 1 and 2 years. HIV-infected women received antiretroviral therapy (ART) as per local guidelines. The association between HIV and antiretroviral exposure with lung function was assessed using mixed effects modelling. Results: Of 1143 infants born, two HIV-infected infants were excluded from analysis; 909 (80%) infants had lung function collected at 6 weeks [190 (21%) were HIV-exposed uninfected (HEU)]; 782 (69%) at 1 year and 741 (65%) at 2 years. At 6 weeks HEU infants had larger tidal volume compared with HIV-unexposed infants (1.13 ml, confidence interval: 0.02-2.23, P ¼ 0.045). High maternal viral load was associated with a 17% lower expiratory flow over 2 years (0.17, confidence interval 0.00-0.34, P ¼ 0.046). First-line ART initiated during pregnancy was associated with lower infant tidal volume at 6 weeks compared with those who initiated ART before pregnancy (À2.7 ml, À5.31 to À0.10, P ¼ 0.042), and low maternal CD4 þ cell counts associated with lower infant tidal over 2 years (À11.1 ml, À18.58-3.58, P ¼ 0.004). Conclusion: HIV exposure is associated with altered lung function in early life, with a vulnerable HEU subgroup based on maternal disease severity, immunological compromise and ART exposure. These data highlight the importance of ongoing surveillance of respiratory health in HEU children.

Improving lung health in low-income and middle-income countries: from challenges to solutions

“…18 Whilst HIV-exposed but uninfected infants may have reduced early lung function, by the age of two years impairment is seen only in those children whose mothers had poorly controlled HIV disease during pregnancy. 19 Premature birth: Premature births occur in 10% of all live births globally, but 80% of these are in LMICs. 20 Preterm birth is associated with increased respiratory symptoms, airway obstruction, abnormal lung structure, and poorer cardiovascular health in childhood and early adulthood.…”

Emerging priorities for HIV service delivery

“…Shame and fear of negative attitudes can lead people to be reluctant to return to care following disengagement [56]. In South Africa, clinics have piloted a successful "welcome back" counseling strategy that provides a nonjudgmental approach to reengagement in care [58]. Communicating acceptance also has encouraged reengagement in care in other settings [59].…”

Determinants of lung health across the life course in sub-Saharan Africa

“…69 HIV-exposed, non-infected children show altered lung function in early life, with greatest risk for children of mothers with more severe disease. 70 Both immunocompetent and HIV-infected children are at risk of TB infection in high-burden countries. 3 Late diagnosis or inadequate treatment, may lead to long-term lung complications, including scarring and bronchiectasis.…”