Clinical and immunological correlates of chest X-ray abnormalities in HIV-infected South African children with limited access to anti-retroviral therapy.

ABSTRACT

BACKGROUND: The chest X-ray (CXR) abnormalities of human immunodeficiency virus (HIV)-infected children in low/middle income countries (LMIC's) have not been well studied. OBJECTIVE: To describe the CXR abnormalities and associated clinical/immunological features in HIV-infected South African children. MATERIALS AND METHODS: A prospective study of HIV-infected children who underwent baseline chest radiography and clinical and immunological HIV-staging. CXR abnormalities were stratified as grade 1 (mild) or grade 2 (moderate/severe). Univariate and multiple logistic regression analyses assessed associations between radiological severity and clinical/immunological parameters. RESULTS: Three hundred thirty children (53% male), median age 23.8 months, were included; 303 (92%) had moderate/severe clinical disease and 225 (68%) moderate/severe immune suppression; 52 (16%) had a normal CXR; 169 (51%) had grade 2 CXR abnormalities, manifesting as confluent opacification (n = 91, 28%), nodules (n = 37, 11%), or nodules with opacification (n = 41, 12%) Grade 2 abnormality was associated with more advanced clinical HIV disease (OR 6.9; 95% CI 1.9-25.6), CD4+ less than 20% (OR 1.8; 95% CI 1.0-3.0) and age over 24 months (OR 4.1; 95% CI 2.1-8.0). CONCLUSION: CXR abnormalities are common in HIV-infected children in LMIC's. The extent of radiological abnormality correlates with age and clinical and immunological severity of HIV-disease.