Clinical and immunological correlates of chest X‐ray abnormalities in HIV‐infected South African children with limited access to anti‐retroviral therapy

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.