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J Allergy Clin Immunol. 2017 Oct;140(4):1101-1111.e7. doi: 10.1016/j.jaci.2017.01.031. Epub 2017 Mar 6.

Long-term pulmonary complications in perinatally HIV-infected youth.

Author information

Department of Pediatrics, Baylor College of Medicine, and the Department of Allergy and Immunology, Texas Children's Hospital, Houston, Tex. Electronic address:
Department of Biostatistics, Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Mass.
Maternal Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md.
Bronx Lebanon Hospital Center, New York, NY.
Frontier Science & Technology Research Foundation, Amherst, NY.
Department of Pediatrics, Clinical Research Division, University of Miami Miller School of Medicine, Miami, Fla.
Section of Infectious Diseases, Department of Pediatrics, Tulane Medical Center, New Orleans, La.
Pediatric Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Department of Pediatrics, Baylor College of Medicine, and Department of Retrovirology, Texas Children's Hospital, Houston, Tex.
Pediatric Infectious Disease, Children's Diagnostic & Treatment Center, Fort Lauderdale, Fla.
Division of Pediatric Pulmonary, Batchelor Research Institute, Miami, Fla.
Division of Pediatric Pulmonology, Columbia University Medical Center, New York, NY.



Increased incidence and prevalence of asthma have been documented for perinatally HIV-infected youth 10 to 21 years of age compared with HIV-exposed uninfected (HEU) youth.


We sought to perform objective pulmonary function tests (PFTs) in HIV-infected and HEU youth with and without diagnosed asthma.


Asthma was determined in 370 participants (218 HIV-infected and 152 HEU participants) by means of chart review and self-report at 13 sites. Interpretable PFTs (188 HIV-infected and 132 HEU participants) were classified as obstructive, restrictive, or normal, and reversibility was determined after bronchodilator inhalation. Values for HIV-1 RNA, CD4 and CD8 T cells, eosinophils, total IgE, allergen-specific IgE, and urinary cotinine were measured. Adjusted prevalence ratios (PRs) of asthma and PFT outcomes were determined for HIV-infected participants relative to HEU participants, controlling for age, race/ethnicity, and sex.


Current asthma was identified in 75 (34%) of 218 HIV-infected participants and 38 (25%) of 152 HEU participants (adjusted PR, 1.33; P = .11). The prevalence of obstructive disease did not differ by HIV status. Reversibility was less likely in HIV-infected youth than in HEU youth (17/183 [9%] vs 21/126 [17%]; adjusted PR, 0.47; P = .020) overall and among just those with obstructive PFT results (adjusted PR, 0.46; P = .016). Among HIV-infected youth with current asthma, serum IgE levels were inversely correlated with CD8 T-cell counts and positively correlated with eosinophil counts and not associated with CD4 T-cell counts. HIV-infected youth had lower association of specific IgE levels to several inhalant and food allergens compared with HEU participants and significantly lower CD4/CD8 T-cell ratios (suggesting immune imbalance).


Compared with HEU youth, HIV-infected youth demonstrated decreased reversibility of obstructive lung disease, which is atypical of asthma. This might indicate an early stage of chronic obstructive pulmonary disease. Follow-up into adulthood is warranted to further define their pulmonary outcomes.


Pediatric HIV infection; asthma; asthma-COPD overlap syndrome; chronic obstructive pulmonary disease; immune imbalance (T(H)2 shift); obstructive and restrictive pulmonary disease; pulmonary complications of HIV infection; pulmonary function testing; reversibility of obstructive air flow with bronchodilators

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