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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, Munyati S, Barker RD, Miller RF, Bandason T, Wells AU, Corbett EL - Clin. Infect. Dis. (2012)

Bottom Line: 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.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 (r(2) = 0.8) and reduced FEV(1) (r(2) = -0.26).Etiology, prognosis, and response to treatment are currently unknown.

View Article: PubMed Central - PubMed

Affiliation: Clinical Research Department, London School of Hygiene and Tropical Medicine, United Kingdom. rabferr@gmail.com

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 (FEV(1)) 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 (r(2) = 0.8) and reduced FEV(1) (r(2) = -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.

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Lung high-resolution computed tomography findings in participants. A, Image section at the level of the carina in a 15-year-old female. There is a clear zone of decreased attenuation in the right upper lobe (and, to a lesser extent, the left lung). In regions of decreased attenuation there is reduction in the caliber of pulmonary vessels; there was no bronchiectasis in this patient. B, Image section in a 19-year-old male through the lower zones demonstrating focal areas of decreased attenuation in both lungs (arrows) and bronchiectasis in the left lower lobe (arrowheads).
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CIS271F1: Lung high-resolution computed tomography findings in participants. A, Image section at the level of the carina in a 15-year-old female. There is a clear zone of decreased attenuation in the right upper lobe (and, to a lesser extent, the left lung). In regions of decreased attenuation there is reduction in the caliber of pulmonary vessels; there was no bronchiectasis in this patient. B, Image section in a 19-year-old male through the lower zones demonstrating focal areas of decreased attenuation in both lungs (arrows) and bronchiectasis in the left lower lobe (arrowheads).

Mentions: Radiologic findings in the 56 participants who received HRCT scans are summarized in Table 3. Of note, the prevalence of CXR abnormalities was not significantly different between participants meeting case definitions for CLD who received HRCT scans and those who met case definitions but did not undergo HRCT (data not shown). Decreased attenuation consistent with small airway disease was the most common and most extensive HRCT abnormality, followed by (and associated with) large airway abnormalities (bronchial wall thickening, small and large airway plugging, and bronchiectasis; Figure 1, Table 3). Our protocol obtained HRCT images at full inspiration (having not anticipated the high prevalence of small airway disease), but pronounced decreased attenuation was observed in 4 HRCT scans serendipitously performed in the expiratory phase. Ground-glass opacification and nodules were seen in a minority of cases, and features suggesting interstitial lung disease were also rare.Table 3.


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, Munyati S, Barker RD, Miller RF, Bandason T, Wells AU, Corbett EL - Clin. Infect. Dis. (2012)

Lung high-resolution computed tomography findings in participants. A, Image section at the level of the carina in a 15-year-old female. There is a clear zone of decreased attenuation in the right upper lobe (and, to a lesser extent, the left lung). In regions of decreased attenuation there is reduction in the caliber of pulmonary vessels; there was no bronchiectasis in this patient. B, Image section in a 19-year-old male through the lower zones demonstrating focal areas of decreased attenuation in both lungs (arrows) and bronchiectasis in the left lower lobe (arrowheads).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3369563&req=5

CIS271F1: Lung high-resolution computed tomography findings in participants. A, Image section at the level of the carina in a 15-year-old female. There is a clear zone of decreased attenuation in the right upper lobe (and, to a lesser extent, the left lung). In regions of decreased attenuation there is reduction in the caliber of pulmonary vessels; there was no bronchiectasis in this patient. B, Image section in a 19-year-old male through the lower zones demonstrating focal areas of decreased attenuation in both lungs (arrows) and bronchiectasis in the left lower lobe (arrowheads).
Mentions: Radiologic findings in the 56 participants who received HRCT scans are summarized in Table 3. Of note, the prevalence of CXR abnormalities was not significantly different between participants meeting case definitions for CLD who received HRCT scans and those who met case definitions but did not undergo HRCT (data not shown). Decreased attenuation consistent with small airway disease was the most common and most extensive HRCT abnormality, followed by (and associated with) large airway abnormalities (bronchial wall thickening, small and large airway plugging, and bronchiectasis; Figure 1, Table 3). Our protocol obtained HRCT images at full inspiration (having not anticipated the high prevalence of small airway disease), but pronounced decreased attenuation was observed in 4 HRCT scans serendipitously performed in the expiratory phase. Ground-glass opacification and nodules were seen in a minority of cases, and features suggesting interstitial lung disease were also rare.Table 3.

Bottom Line: 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.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 (r(2) = 0.8) and reduced FEV(1) (r(2) = -0.26).Etiology, prognosis, and response to treatment are currently unknown.

View Article: PubMed Central - PubMed

Affiliation: Clinical Research Department, London School of Hygiene and Tropical Medicine, United Kingdom. rabferr@gmail.com

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 (FEV(1)) 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 (r(2) = 0.8) and reduced FEV(1) (r(2) = -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.

Show MeSH
Related in: MedlinePlus