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Chronic lung disease in adolescents with delayed diagnosis of vertically acquired HIV infection.
- Source :
-
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2012 Jul; Vol. 55 (1), pp. 145-52. Date of Electronic Publication: 2012 Apr 02. - Publication Year :
- 2012
-
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.<br />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).<br />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).<br />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.
- Subjects :
- Adolescent
Child
Chronic Disease epidemiology
Female
HIV Infections complications
HIV Infections epidemiology
HIV Infections transmission
Humans
Infectious Disease Transmission, Vertical
Lung diagnostic imaging
Lung pathology
Lung Diseases diagnostic imaging
Lung Diseases epidemiology
Male
Radiography, Thoracic
Respiratory Function Tests
Sputum microbiology
Delayed Diagnosis
HIV Infections diagnosis
Lung Diseases virology
Subjects
Details
- Language :
- English
- ISSN :
- 1537-6591
- Volume :
- 55
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
- Publication Type :
- Academic Journal
- Accession number :
- 22474177
- Full Text :
- https://doi.org/10.1093/cid/cis271