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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

1
Department of Pediatrics, Baylor College of Medicine, and the Department of Allergy and Immunology, Texas Children's Hospital, Houston, Tex. Electronic address: wtsheare@texaschildrens.org.
2
Department of Biostatistics, Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Mass.
3
Maternal Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md.
4
Bronx Lebanon Hospital Center, New York, NY.
5
Frontier Science & Technology Research Foundation, Amherst, NY.
6
Department of Pediatrics, Clinical Research Division, University of Miami Miller School of Medicine, Miami, Fla.
7
Section of Infectious Diseases, Department of Pediatrics, Tulane Medical Center, New Orleans, La.
8
Pediatric Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Ill.
9
Department of Pediatrics, Baylor College of Medicine, and Department of Retrovirology, Texas Children's Hospital, Houston, Tex.
10
Pediatric Infectious Disease, Children's Diagnostic & Treatment Center, Fort Lauderdale, Fla.
11
Division of Pediatric Pulmonary, Batchelor Research Institute, Miami, Fla.
12
Division of Pediatric Pulmonology, Columbia University Medical Center, New York, NY.

Abstract

BACKGROUND:

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.

OBJECTIVE:

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

METHOD:

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.

RESULTS:

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).

CONCLUSION:

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.

KEYWORDS:

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

PMID:
28279683
PMCID:
PMC5587357
DOI:
10.1016/j.jaci.2017.01.031
[Indexed for MEDLINE]
Free PMC Article

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