Long-Term Pulmonary Complications in Perinatally HIV-Infected Youth

Publication date: Available online 6 March 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): William T. Shearer, Denise L. Jacobson, Wendy Yu, George K. Siberry, Murli Purswani, Suzanne Siminski, Laurie Butler, Erin Leister, Gwendolyn Scott, Russell B. Van Dyke, Ram Yogev, Mary E. Paul, Ana Puga, Andrew A. Colin, Meyer Kattan
BackgroundIncreased incidence and prevalence of asthma have been documented for perinatally HIV-infected (HIV) youth 10-21 years of age (youth) compared to HIV-exposed uninfected (HEU) youth.ObjectiveTo perform objective pulmonary function tests (PFTs) in HIV and HEU youth with and without diagnosed asthma.MethodAsthma was determined in 370 participants (218 HIV, 152 HEU) by chart review and self-report at 13 sites. Interpretable PFTs (188 HIV, 132 HEU) were classified as obstructive, restrictive, or normal and reversibility was determined after bronchodilator inhalation. HIV-1 RNA, CD4 and CD8 T-cells, eosinophils, total IgE, allergen-specific IgE, and urinary cotinine were measured. Adjusted prevalence ratios (aPR) of asthma and PFT outcomes were determined for HIV relative to HEU controlling for age, race/ethnicity and sex.ResultsCurrent asthma was identified in 75/218 (34%) HIV and 38/152 (25%) HEU (aPR=1.33, p=0.11). Prevalence of obstructive disease did not differ by HIV status. Reversibility was less likely in HIV youth than in HEU (17/183 (9%) vs. 21/126 (17%), (aPR=0.47, p=0.020) overall and among just those with OBS (aPR=0.46, p=0.016). Among HIV youth with current asthma, serum IgE levels were inversely correlated with CD8 T-cell, and positively correlated with eosinophil counts, and not associated with CD4 T-cells. HIV youth had lower association of specific IgE to several inhalant and food allergens compared to HEU and significantly lower CD4/CD8 T-cell ratios (suggesting immune imbalance).ConclusionCompared to HEU, HIV youth demonstrated decreased reversibility of obstructive lung disease, atypical of asthma. This may indicate an early stage of chronic obstructive pulmonary disease. Follow-up into adulthood is warranted to further define their pulmonary outcomes.

Teaser

Diagnosis of asthma in HIV-infected youth may not be due to asthma alone but rather to a combination of asthma and chronic obstructive pulmonary disease based upon lower rates of reversibility after bronchodilator inhalation. Long-term follow-up of these patients may reveal the origin of their pulmonary findings.


http://ift.tt/2lyRxaL