RT Journal Article
SR Electronic
T1 Childhood lung function following perinatal HIV infection and early antiretroviral therapy initiation: a cross-sectional study
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00691-2021
DO 10.1183/23120541.00691-2021
VO 8
IS 1
A1 Andre Gie
A1 Julie Morrison
A1 David Maree
A1 Barbara Laughton
A1 Sara H. Browne
A1 Mark F. Cotton
A1 Pierre Goussard
A1 Steve Innes
YR 2022
UL http://openres.ersjournals.com/content/8/1/00691-2021.abstract
AB Despite the introduction of antiretroviral therapy (ART), HIV-associated pulmonary complications remain prevalent in children following perinatal HIV infection. In the post-ART era the incidence of opportunistic infections has decreased; however, non-infectious complications including diminished lung function are common. It is unclear whether early initiation of ART influences lung function later in life.We performed a cross-sectional study examining pulmonary function tests (PFT) (spirometry, plethysmography, carbon monoxide diffusing capacity) in HIV-unexposed (HU), HIV-exposed-uninfected (HEU) and perinatally HIV-infected children on early ART (HIV+) recruited from the Cape Town arms of the CHER and IMPAACT 1060 trials. PFT was performed once children could participate (October 2013 to January 2020). Global Lung Initiative reference software was used for Z-standardisation of lung function by sex, age and height.In total 394 children (HU n=90, HEU n=162, HIV+ n=142) underwent PFT, median age 8.7 (IQR 7.7–9.8) years. HIV+ had ART initiated at a median age of 17.6 (8.0–36.7) weeks. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC Z-scores were similar in all groups. Plethysmography demonstrated air-trapping with increased total lung capacity (TLC), functional residual capacity, residual volume (RV) and RV/TLC Z-scores in HIV+. There were no differences in alveolar volume; however, diffusing capacity was increased in HIV+.Our findings indicate that following perinatal HIV infection, early ART may attenuate HIV-associated lung disease and is associated with normal childhood spirometry. However plethysmography demonstrates that small airway dysfunction is more pronounced in HIV+. Longitudinal follow-up is required to assess if these children are at risk of obstructive airway disease later in life.Early ART benefits childhood lung function. Perinatally HIV-infected children with early ART have similar spirometry to HIV unexposed. However, they may be at risk of obstructive lung disease later in life due to small airway dysfunction. https://bit.ly/3oIBGow