Long-term pulmonary complications in perinatally HIV-infected youth

Background Increased incidence and prevalence of asthma have been documented for perinatally HIV-infected youth 10 to 21 years of age compared with HIV-exposed uninfected (HEU) youth. Objective We sought to perform objective pulmonary function tests (PFTs) in HIV-infected and HEU youth with and with...

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Published in:Journal of allergy and clinical immunology 2017-10, Vol.140 (4), p.1101-1111.e7
Main Authors: Shearer, William T., MD, PhD, Jacobson, Denise L., PhD, MPH, Yu, Wendy, MPH, Siberry, George K., MD, MPH, Purswani, Murli, MD, Siminski, Suzanne, MS, MBA, Butler, Laurie, MBA, MT, Leister, Erin, MS, Scott, Gwendolyn, MD, Van Dyke, Russell B., MD, Yogev, Ram, MD, Paul, Mary E., MD, Puga, Ana, MD, Colin, Andrew A., MD, Kattan, Meyer, MD
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adolescent
AIDS
Allergens
Allergy and Immunology
Asthma
Asthma - epidemiology
Asthma - immunology
asthma-COPD overlap syndrome
Bronchodilators
CD4 antigen
CD4-Positive T-Lymphocytes - immunology
CD8 antigen
CD8-Positive T-Lymphocytes - immunology
Chronic obstructive pulmonary disease
Complications
Cotinine
Eosinophils
Eosinophils - immunology
Female
Food allergies
HIV
HIV Infections - epidemiology
HIV Infections - immunology
HIV-1 - physiology
Human immunodeficiency virus
Humans
immune imbalance (TH2 shift)
Immunoglobulin E
Immunoglobulin E - metabolism
Incidence
Inhalation
Leukocytes (eosinophilic)
Lung diseases
Lymphocytes
Lymphocytes T
Male
Maternal Exposure - adverse effects
Minority & ethnic groups
obstructive and restrictive pulmonary disease
Obstructive lung disease
Pediatric HIV infection
Pregnancy
Prenatal Exposure Delayed Effects - epidemiology
Prenatal Exposure Delayed Effects - immunology
Prevalence
pulmonary complications of HIV infection
pulmonary function testing
Pulmonary functions
Respiration
Respiratory function
Respiratory Function Tests
reversibility of obstructive air flow with bronchodilators
Ribonucleic acid
RNA
Studies
Time Factors
United States
Viral Load
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Summary:Background Increased incidence and prevalence of asthma have been documented for perinatally HIV-infected youth 10 to 21 years of age compared with HIV-exposed uninfected (HEU) youth. Objective We sought to perform objective pulmonary function tests (PFTs) in HIV-infected and HEU youth with and without diagnosed asthma. Method Asthma was determined in 370 participants (218 HIV-infected and 152 HEU participants) by means of chart review and self-report at 13 sites. Interpretable PFTs (188 HIV-infected and 132 HEU participants) were classified as obstructive, restrictive, or normal, and reversibility was determined after bronchodilator inhalation. Values for HIV-1 RNA, CD4 and CD8 T cells, eosinophils, total IgE, allergen-specific IgE, and urinary cotinine were measured. Adjusted prevalence ratios (PRs) of asthma and PFT outcomes were determined for HIV-infected participants relative to HEU participants, controlling for age, race/ethnicity, and sex. Results Current asthma was identified in 75 (34%) of 218 HIV-infected participants and 38 (25%) of 152 HEU participants (adjusted PR, 1.33; P  = .11). The prevalence of obstructive disease did not differ by HIV status. Reversibility was less likely in HIV-infected youth than in HEU youth (17/183 [9%] vs 21/126 [17%]; adjusted PR, 0.47; P  = .020) overall and among just those with obstructive PFT results (adjusted PR, 0.46; P  = .016). Among HIV-infected youth with current asthma, serum IgE levels were inversely correlated with CD8 T-cell counts and positively correlated with eosinophil counts and not associated with CD4 T-cell counts. HIV-infected youth had lower association of specific IgE levels to several inhalant and food allergens compared with HEU participants and significantly lower CD4/CD8 T-cell ratios (suggesting immune imbalance). Conclusion Compared with HEU youth, HIV-infected youth demonstrated decreased reversibility of obstructive lung disease, which is atypical of asthma. This might indicate an early stage of chronic obstructive pulmonary disease. Follow-up into adulthood is warranted to further define their pulmonary outcomes.
ISSN:0091-6749
1097-6825
DOI:10.1016/j.jaci.2017.01.031