Abstract
BackgroundThe advent of antiretroviral therapy has led to the improved survival of human immunodeficiency virus (HIV)-infected children to adulthood and to HIV becoming a chronic disease in older children and adolescents. Chronic lung disease is common among HIV-infected adolescents. Lung function measurement may help to delineate the spectrum, pathophysiology and guide therapy for HIV-related chronic lung disease.AimThe aim of this study was to review the available data on the spectrum and determinants of lung function abnormalities and the impact of antiretroviral therapy on lung function in perinatally HIV-infected children and adolescents.MethodsElectronic databases “PUBMED”, “African wide” and “CINAHL” via EBSCO Host, using the MeSH terms “Respiratory function” AND “HIV” OR “Acquired Immunodeficiency Syndrome” AND “Children” OR “Adolescents”, were searched for relevant articles on lung function in HIV-infected children and adolescents. The search was limited to English language articles published between January 1984 and September 2017.ResultsEighteen articles were identified, which included studies from Africa, the United States of America (USA) and Italy, representing 2051 HIV-infected children and adolescents, 68% on antiretroviral therapy, aged from 50 days to 24 years. Lung function abnormalities showed HIV-infected participants had increased irreversible lower airway expiratory obstruction and reduced functional aerobic impairment on exercise, compared to HIV-uninfected participants. Mosaic attenuation, extent of bronchiectasis, history of previous pulmonary tuberculosis or previous lower respiratory tract infection and cough for more than 1 month were associated with low lung function. Pulmonary function tests in children established on antiretroviral therapy did not show aerobic impairment and had less severe airway obstruction.ConclusionThere is increasing evidence that HIV-infected children and adolescents have high prevalence of lung function impairment, predominantly irreversible lower airway obstruction and reduced aerobic function.
Highlights
The advent of antiretroviral therapy has led to the improved survival of human immunodeficiency virus (HIV)-infected children to adulthood and to HIV becoming a chronic disease in older children and adolescents
Pulmonary function tests in children established on antiretroviral therapy did not show aerobic impairment and had less severe airway obstruction
Lung function impairment starts early in life in the absence of antiretroviral therapy (ART), as evidenced by the papers published in the pre-ART era
Summary
The advent of antiretroviral therapy has led to the improved survival of human immunodeficiency virus (HIV)-infected children to adulthood and to HIV becoming a chronic disease in older children and adolescents. Improved survival of perinatally human immunodeficiency virus (HIV)-infected children to adolescence has occurred with the scale-up of pediatric antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) programs. This has led to a large cohort of youth living with vertically transmitted HIV in sub-Saharan Africa [1]. In the post-ART era, the spectrum of CLD has changed from lymphocytic interstitial pneumonitis (LIP) being most predominant to bronchiolitis obliterans and bronchiectasis being more prevalent patterns [5, 6].
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