Childhood lung function following perinatal HIV infection and early antiretroviral therapy initiation: a cross-sectional study

Andre Gie; Julie Morrison; David Maree; Barbara Laughton; Sara H Browne; Mark F Cotton; Pierre Goussard; Steve Innes

doi:10.1183/23120541.00691-2021

Childhood lung function following perinatal HIV infection and early antiretroviral therapy initiation: a cross-sectional study

ERJ Open Res. 2022 Mar 21;8(1):00691-2021. doi: 10.1183/23120541.00691-2021. eCollection 2022 Jan.

Authors

Andre Gie¹, Julie Morrison¹, David Maree², Barbara Laughton^{1

3}, Sara H Browne⁴, Mark F Cotton^{1

3}, Pierre Goussard¹, Steve Innes^{1

3

5}

Affiliations

¹ Dept of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa.
² Dept of Medicine, Division of Pulmonology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa.
³ Family Center for Research with Ubuntu (FAMCRU), Stellenbosch University, Cape Town, South Africa.
⁴ Dept of Medicine, University of California San Diego, San Diego, CA, USA.
⁵ Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.

Abstract

Despite the introduction of antiretroviral therapy (ART), HIV-associated pulmonary complications remain prevalent in children following perinatal HIV infection. In the post-ART era the incidence of opportunistic infections has decreased; however, non-infectious complications including diminished lung function are common. It is unclear whether early initiation of ART influences lung function later in life. We performed a cross-sectional study examining pulmonary function tests (PFT) (spirometry, plethysmography, carbon monoxide diffusing capacity) in HIV-unexposed (HU), HIV-exposed-uninfected (HEU) and perinatally HIV-infected children on early ART (HIV⁺) recruited from the Cape Town arms of the CHER and IMPAACT 1060 trials. PFT was performed once children could participate (October 2013 to January 2020). Global Lung Initiative reference software was used for Z-standardisation of lung function by sex, age and height. In total 394 children (HU n=90, HEU n=162, HIV⁺ n=142) underwent PFT, median age 8.7 (IQR 7.7-9.8) years. HIV⁺ had ART initiated at a median age of 17.6 (8.0-36.7) weeks. Forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC) and FEV₁/FVC Z-scores were similar in all groups. Plethysmography demonstrated air-trapping with increased total lung capacity (TLC), functional residual capacity, residual volume (RV) and RV/TLC Z-scores in HIV⁺. There were no differences in alveolar volume; however, diffusing capacity was increased in HIV⁺. Our findings indicate that following perinatal HIV infection, early ART may attenuate HIV-associated lung disease and is associated with normal childhood spirometry. However plethysmography demonstrates that small airway dysfunction is more pronounced in HIV⁺. Longitudinal follow-up is required to assess if these children are at risk of obstructive airway disease later in life.

Abstract

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