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Chronic lung disease in children and adolescents with HIV: a case–control study
Author(s) -
McHugh Grace,
Rehman Andrea M.,
Simms Victoria,
GonzalezMartinez Carmen,
Bandason Tsitsi,
Dauya Ethel,
Moyo Brewster,
Mujuru Hilda,
Rylance Jamie,
Sovershaeva Evgeniya,
Weiss Helen A.,
Kranzer Katharina,
Odland Jon,
Ferrand Rashida A.
Publication year - 2020
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13375
Subject(s) - medicine , pediatrics , logistic regression , wasting , copd , chronic cough , asthma
Objective To describe the features of HIV‐associated chronic lung disease (CLD) in older children and adolescents living with HIV and to examine the clinical factors associated with CLD. This is a post hoc analysis of baseline data from the BREATHE clinical trial ( ClinicalTrials.gov , NCT02426112). Methods Children and adolescents aged 6–19 years were screened for CLD (defined as a FEV1 z ‐score <−1 with no reversibility post‐bronchodilation with salbutamol) at two HIV clinics in Harare, Zimbabwe, and Blantyre, Malawi. Eligible participants with CLD (cases) were enrolled, together with a control group without CLD [frequency‐matched by age group and duration on antiretroviral therapy (ART)] in a 4:1 allocation ratio. A clinical history and examination were undertaken. The association between CLD and a priori ‐defined demographic and clinical covariates was investigated using multivariable logistic regression. Results Of the 1585 participants screened, 419 (32%) had a FEV1 z ‐score <−1, of whom 347 were enrolled as cases [median age 15.3 years (IQR 12.7–17.7); 48.9% female] and 74 with FEV1 z ‐score >0 as controls [median age 15.6 years (IQR 12.1–18.2); 62.2% female]. Among cases, current respiratory symptoms including cough and shortness of breath were reported infrequently (9.3% and 1.8%, respectively). However, 152 (43.8%) of cases had a respiratory rate above the 90th centile for their age. Wasting and taking second‐line ART were independently associated with CLD. Conclusions The presence of CLD indicates the need to address additional treatment support for youth living with HIV, alongside ART provision, to ensure a healthier adulthood.