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Clinical and immunological correlates of chest X‐ray abnormalities in HIV‐infected South African children with limited access to anti‐retroviral therapy
Author(s) -
Pitcher Richard D.,
Lombard Carl,
Cotton Mark F.,
Beningfield Stephen J.,
Zar Heather J.
Publication year - 2014
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.22840
Subject(s) - medicine , logistic regression , prospective cohort study , radiological weapon , univariate analysis , abnormality , pediatrics , gastroenterology , surgery , multivariate analysis , psychiatry
Summary Background The chest X‐ray (CXR) abnormalities of human immunodeficiency virus (HIV)‐infected children in low/middle income countries (LMIC's) have not been well studied. Objective To describe the CXR abnormalities and associated clinical/immunological features in HIV‐infected South African children. Materials and Methods A prospective study of HIV‐infected children who underwent baseline chest radiography and clinical and immunological HIV‐staging. CXR abnormalities were stratified as grade 1 (mild) or grade 2 (moderate/severe). Univariate and multiple logistic regression analyses assessed associations between radiological severity and clinical/immunological parameters. Results Three hundred thirty children (53% male), median age 23.8 months, were included; 303 (92%) had moderate/severe clinical disease and 225 (68%) moderate/severe immune suppression; 52 (16%) had a normal CXR; 169 (51%) had grade 2 CXR abnormalities, manifesting as: confluent opacification (n = 91, 28%), nodules (n = 37, 11%), or nodules with opacification (n = 41, 12%) Grade 2 abnormality was associated with more advanced clinical HIV disease (OR: 6.9; 95% CI: 1.9–25.6), CD4+ less than 20% (OR: 1.8; 95% CI: 1.0–3.0) and age over 24 months (OR: 4.1; 95% CI: 2.1–8.0). Conclusion CXR abnormalities are common in HIV‐infected children in LMIC's. The extent of radiological abnormality correlates with age and clinical and immunological severity of HIV‐disease. Pediatr Pulmonol. 2014; 49:581–588. © 2013 Wiley Periodicals, Inc.