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

Abstract

BACKGROUND-Immunoreconstitution of HIV-infected (HIV+) patients after treatment with highly antiretroviral therapy (HAART) appears to provoke inflammatory diseases.

HLA-DRB1454 and predictors of new-onset asthma in HIV-infected Thai children

“…In fact, the incidence of asthma in the immediate-arm (26.5%) exceeded those that were seen in healthy Thai children (18%) [7]. Together with other reports [1,2], these data support the contribution of immune reconstitution on the development of asthma following ART initiation. Low household income and HLADRB1454 were also predictive of asthma.…”

“…Recent cohort studies have demonstrated a rise in asthma incidence following antiretroviral therapy (ART) in US children living with HIV [1][2][3], possibly due to immune reconstitution [2]. As the extent of immune reconstitution can be affected by the pre-ART CD4 level, we assessed new onset asthma in a randomized study of children who initiated ART at different CD4 levels in the Pediatric Randomized Early versus Deferred Initiation in Cambodia and Thailand study (The PREDICT study) [4].…”

“…inhaled budesonide, unspecified oral/inhaled bronchodilator, and salbutamol + budesonide) (12.5%). Median (IQR) durations of medications use were 16 (10-41) days for salbutamol, 7 [5][6][7][8] days for terbutaline, 167 (34-427) days for budesonide, and 5 [2][3][4][5][6] days for bronchodilator with no differences between arms (all p N 0.2).…”

Respiratory syncytial virus neutralizing antibodies in cord blood, respiratory syncytial virus hospitalization, and recurrent wheeze

“…[34][35][36][37] Furthermore, a recent study among HIV-infected children and young adults showed a steep increase in asthma prevalence after highly active antiretroviral therapy, presumably because activated CD4 1 and CD8 1 T cells and T H 2 inflammatory cytokines IL-4 and IL-13 contributed to pulmonary hypersensitivity. 38 Maternal RSV immunization during pregnancy has been described as safe and protective 39 ; however, we know only little about the effect of wild-type RSV infection during pregnancy on the maternal immune system. A previous study found that antenatal sensitization occurs in a third of infants exposed to an RSV epidemic at the appropriate time of gestation and suggested that in utero exposure to RSV infection might influence the subsequent immune response on postnatal exposure to RSV.…”

HIV and asthma, is there an association?

“…11–13 However, our current understanding of the underlying mechanisms accounting for this association and the role of anti-retrovirals in HIV-associated pulmonary complications is incomplete and we are unable to answer key questions such as: What are the effects of HAART on the pulmonary system? Does HAART modify the Th1/Th2 balance and thus increase the risk of asthma?…”