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High‐resolution computed tomography features of lung disease in perinatally HIV‐infected adolescents on combined antiretroviral therapy
Author(s) -
du Plessis AnneMarie,
Andronikou Savvas,
Machemedze Takwanisa,
GriffithRichards Stephanie,
Myer Landon,
Mahtab Sana,
Zar Heather J.
Publication year - 2019
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.24450
Subject(s) - medicine , bronchiectasis , bronchiolitis obliterans , air trapping , high resolution computed tomography , dlco , lung volumes , pulmonary function testing , population , lung , pneumonia , bronchiolitis , pediatrics , radiology , diffusing capacity , lung function , respiratory system , lung transplantation , environmental health
Abstract Introduction Chronic lung disease is common in perinatally HIV‐infected children as they increasingly surviving into adolescence. There are few data on the radiologic spectrum of disease in this population. Methods Contrasted high‐resolution computed tomography (HRCT) was performed in ambulatory South African adolescents enrolled in a prospective study of perinatally‐infected adolescents aged 9 to 14 years established on combined antiretroviral therapy (cART) and followed for 36 months. Consecutive participants with reduced lung function (defined by a forced expiratory volume in 1 second [FEV1] of <80% normal and/or lung diffusion capacity [DLCO] <80% normal] underwent HRCT. History, clinical, and laboratory data were collected. Two radiologists blinded to clinical data and to each other, reported scans using standardized methodology; a third radiologist resolved discrepancies. Results Amongst 100 participants undergoing HRCT, median age was 13.8 years (12.8‐15.1). The median duration on cART was 8.4 years (IQR = 5.7‐9.8). Mosaic attenuation was the most common finding (73%). Of these 71 (91%) demonstrated associated air trapping radiologically consistent with bronchiolitis obliterans. Bronchiectasis occurred in 39% with significant correlation between extent of bronchiectasis and mosaic attenuation ( r = 0.57, P < .001). Prior hospitaliszation for childhood pneumonia at any time before enrollment was associated with mosaic attenuation (OR = 3.9, 95%CI, [1.2‐12.5]); prior pulmonary tuberculosis (TB) was associated with the combination of mosaic attenuation and bronchiectasis (OR = 4.9, 95%CI, [1.6‐15.7]). Most participants (86%) with mosaic attenuation had stage III or IV HIV disease at time of HIV diagnosis (OR = 3.6; [0.9‐14.9]). Inter observer agreement between the two readers was good for bronchiectasis ( K = 0.71) and moderate for mosaic attenuation ( K = 0.51). Discussion Despite well‐controlled HIV and long duration of cART, HRCT changes were common in perinatally HIV‐infected adolescents. There was a high prevalence of small airways disease with and without associated bronchiectasis. These changes were associated with prior pulmonary TB or prior severe pneumonia. Strategies to prevent and treat early life respiratory infection must be strengthened to reduce the burden of chronic lung disease in HIV‐infected adolescents.