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Chronic Lung Disease in Adolescents With Delayed Diagnosis of Vertically Acquired HIV Infection

Ferrand, RA; Desai, SR; Hopkins, C; Elston, CM; Copley, SJ; Nathoo, K; Ndhlovu, CE; ... Corbett, EL; + view all (2012) Chronic Lung Disease in Adolescents With Delayed Diagnosis of Vertically Acquired HIV Infection. Clinical Infectious Diseases , 55 (1) pp. 145-152. 10.1093/cid/cis271. Green open access

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Abstract

BACKGROUND: Long-term survivors of vertically acquired human immunodeficiency virus (HIV) infection are reaching adolescence in large numbers in Africa and are at high risk of delayed diagnosis and chronic complications of untreated HIV infection. Chronic respiratory symptoms are more common than would be anticipated based on the HIV literature. METHODS: Consecutive adolescents with presumed vertically acquired HIV attending 2 HIV care clinics in Harare, Zimbabwe, were recruited and assessed with clinical history and examination, CD4 count, pulmonary function tests, Doppler echocardiography, and chest radiography (CXR). Those with suspected nontuberculous chronic lung disease (CLD) were scanned using high-resolution computed tomography (HRCT). RESULTS: Of 116 participants (43% male; mean age, 14 ± 2.6 years, mean age at HIV diagnosis, 12 years), 69% were receiving antiretroviral therapy. Chronic cough and reduced exercise tolerance were reported by 66% and 21% of participants, respectively; 41% reported multiple respiratory tract infections in the previous year, and 10% were clubbed. More than 40% had hypoxemia at rest (13%) or on exercise (29%), with pulmonary hypertension (mean pulmonary artery pressure >25 mm Hg) in 7%. Forced expiratory volume in 1 second (FEV1) was <80% predicted in 45%, and 47% had subtle CXR abnormalities. The predominant HRCT pattern was decreased attenuation as part of a mosaic attenuation pattern (31 of 56 [55%]), consistent with small airway disease and associated with bronchiectasis (Spearman correlation coefficient (r2 = 0.8) and reduced FEV1 (r2 = −0.26). Conclusions. Long-term survivors of vertically acquired HIV in Africa are at high risk of a previously undescribed small airway disease, with >40% of unselected adolescent clinic attendees meeting criteria for severe hypoxic CLD. This condition is not obvious at rest. Etiology, prognosis, and response to treatment are currently unknown.

Type: Article
Title: Chronic Lung Disease in Adolescents With Delayed Diagnosis of Vertically Acquired HIV Infection
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/cid/cis271
Publisher version: http://dx.doi.org/10.1093/cid/cis271
Language: English
Additional information: © The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited
Keywords: Immunology, Infectious Diseases, Microbiology, PRIMARY-HEALTH-CARE, CYSTIC-FIBROSIS, CONSTRICTIVE BRONCHIOLITIS, INTERSTITIAL PNEUMONIA, ANTIRETROVIRAL THERAPY, YOUNG-CHILDREN, INFLAMMATION, AIRWAY, AIDS, CT hiv, clubbing, computed tomography, doppler echocardiography, hypoxia, pulmonary hypertension, bronchiectasis, cough, chronic lung disease, chronic, adolescen,t exercise, forced expiratory volume function, high resolution ct of lungs, Africa, cd4 count determination procedure, exercise tolerance, chest x-ray, respiratory tract infections, signs and symptoms, respiratory, survivors, Zimbabwe, infection, diagnosis, mosaicism, pulmonary function, tests, hiv infection, anti-retroviral agents, airway device, delayed diagnosis, attenuation, pulmonary artery mean pressure
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1354424
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