Long-term pulmonary complications in perinatally HIV-infected youth.
J Allergy Clin Immunol
; 140(4): 1101-1111.e7, 2017 Oct.
Article
em En
| MEDLINE
| ID: mdl-28279683
ABSTRACT
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.Palavras-chave
Pediatric HIV infection; asthma; asthma-COPD overlap syndrome; chronic obstructive pulmonary disease; immune imbalance (T(H)2 shift); obstructive and restrictive pulmonary disease; pulmonary complications of HIV infection; pulmonary function testing; reversibility of obstructive air flow with bronchodilators
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Efeitos Tardios da Exposição Pré-Natal
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Asma
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Linfócitos T CD4-Positivos
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Infecções por HIV
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HIV-1
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Linfócitos T CD8-Positivos
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Eosinófilos
Tipo de estudo:
Clinical_trials
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Incidence_studies
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Prevalence_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adolescent
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Female
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Humans
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Male
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Pregnancy
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article