Risk Factors for Hypoxia and Tachypnea Among Adolescents With Vertically-acquired HIV in Nairobi

Abstract

Background Chronic lung diseases are increasingly recognized complications of vertically-acquired HIV among adolescents in sub-Saharan Africa and may manifest with hypoxia or tachypnea. We sought to determine the prevalence of and risk factors for hypoxia and tachypnea among adolescents with vertically-acquired HIV in Nairobi, Kenya. Methods We performed a cross-sectional analysis of 258 adolescents with vertically-acquired HIV who were initiating care at the Coptic Hope Center for Infectious Diseases. Adolescents with documented pneumonia were excluded. Hypoxia was defined as resting oxygen saturation ≤92%, and tachypnea was based on the 99th percentile of age-appropriate respiratory rates. Logistic regression models adjusted for demographics and HIV severity estimated odds ratios (ORs) for risk of hypoxia and tachypnea associated with potential risk factors. Results Overall, 11% of adolescents had hypoxia and 55% had tachypnea. Advanced HIV (adjusted OR [aOR] 2.41) and low CD4 (aOR 1.74) were associated with greater hypoxia risk, but confidence intervals (CI) were wide and included the null (95% CI 0.93–6.23 and 0.69–4.39, respectively). Low CD4 (aOR 2.45, 95% CI 1.39–4.32), current ART use (aOR 0.48, 95% CI 0.27–0.86) and stunted growth (aOR 3.46, 95% CI 1.94–6.18) were associated with altered tachypnea risk. Conclusions Hypoxia and tachypnea are common among adolescents with vertically-acquired HIV. There was a suggestion that advanced HIV and low CD4 were associated with greater hypoxia risk. Low CD4, lack of ART use and stunted growth are risk factors for tachypnea. Our findings highlight the chronic lung disease burden in this population and may inform diagnostic algorithms.

Bronchiectasis and other chronic lung diseases in adolescents living with HIV

“…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*].…”

“…Additionally, in contrast with high-income settings where the majority of HIV-infected children initiate ART in infancy, a substantial proportion of children are diagnosed with HIV and initiate ART in later childhood. Among adolescents with delayed diagnosis of perinatally-acquired HIV in sub-Saharan Africa, older age and low FEV 1 and FVC z -scores appear to be associated [9*,11*,13*,15*]. This might reflect accumulation of insults over time and survivor bias.…”

“…Malnutrition during the first year of life is associated with decreased lung function at one year of age [52*]. In a Kenyan study, stunting was associated with tachypnoea among HIV-infected adolescents [9*]. Stunting is a marker of delayed somatic growth; therefore, stunted children are likely to have smaller lungs [77*], which may subsequently predispose to CLD.…”

“…In particular, adolescents with delayed diagnosis of perinatally-acquired HIV have a disproportionately high burden of chronic respiratory disease [8*,9*,10*,11*]. We review the spectrum of and risk factors for HIV-associated CLD among adolescents living with HIV, as well as considerations in diagnosis and management.…”

Human Immunodeficiency Virus-Associated Chronic Lung Disease in Children and Adolescents in Zimbabwe: Chest Radiographic and High-Resolution Computed Tomographic Findings

“…However, recent studies from sub-Saharan Africa have reported a high prevalence of chronic lung disease, even among older children receiving ART [ 5–7 ]. The typical clinical picture is of a chronic, usually nonproductive, cough, hypoxia, tachypnea, reduced exercise tolerance and decreased lung function, and “nonspecific” chest radiographic abnormalities [ 8 ]. Plain chest radiography, despite its ready availability, is insensitive, and terminology used to define abnormalities often inconsistent.…”