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. 2008 Jul;122(1):159-65.
doi: 10.1016/j.jaci.2008.04.043. Epub 2008 Jun 10.

Increased incidence of asthma in HIV-infected children treated with highly active antiretroviral therapy in the National Institutes of Health Women and Infants Transmission Study

Samuel B Foster  1 , Kenneth McIntosh, Bruce Thompson, Ming Lu, Wanrong Yin, Kenneth C Rich, Hermann Mendez, Leslie K Serchuck, Clemente Diaz, Mary E Paul, William T Shearer
Affiliations

Increased incidence of asthma in HIV-infected children treated with highly active antiretroviral therapy in the National Institutes of Health Women and Infants Transmission Study

Samuel B Foster et al. J Allergy Clin Immunol. 2008 Jul.

Abstract

Background: Immunoreconstitution of HIV(+) patients after treatment with highly active antiretroviral therapy (HAART) appears to provoke inflammatory diseases.

Objective: We sought to determine whether HIV(+) children receiving HAART (HIV(+) HAART(+)) have a higher incidence of asthma than HIV(+) children not receiving HAART (HIV(+) HAART(-)).

Methods: Two thousand six hundred sixty-four children (193 HIV(+) and 2471 HIV(-) children) born to HIV(+) women were evaluated for the incidence and prevalence of asthma (ie, asthma medication use) and change of CD4(+) T-cell percentage with time.

Results: The HIV(+) HAART(+) children had higher CD4(+) T-cell percentages, lower CD8(+) T-cell percentages, and lower viral burdens than the HIV(+) HAART(-) children (P < or = .05 to P < or = .01). The cumulative incidence of asthma medication use in HIV(+) HAART(+) children at 13.5 years increased to 33.5% versus 11.5% in HIV(+) HAART(-) children (hazard ratio, 3.34; P = .01) and was equal to that in the HIV(-) children. In children born before the HAART era, the prevalence of asthma medication use for HIV(+) HAART(+) children at 11 years of age was 10.4% versus 3.8% for HIV(+) HAART(-) children (odds ratio, 3.38; P = .02) and was equal to that of the HIV(-) children. The rate of change of CD4(+) T cells around the time of first asthma medication for HIV(+) HAART(+) versus HIV(+) HAART(-) children was 0.81%/y versus -1.43%/y (P = .01).

Conclusion: The increased incidence of asthma in HIV(+) HAART(+) children might be driven by immunoreconstitution of CD4(+) T cells.

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Figures

Fig. 1
Fig. 1
Survival analysis results for the time-to-first asthma medication use. Cox model estimates relating differences between children according to HIV infection status and HAART use (in the HIV+ group) and respective P values are annotated in the lower right hand portion of the graph. Estimated cumulative incidences for each group at 2, 5, 10, and 13.5 years of age are annotated in the upper left-hand portion of the graph.
Fig. 2
Fig. 2
Prevalence of asthma medication use for children born in the pre-HAART era using GEE. Data are presented using a three point moving average. No asthma medications were used by any group before 60 months.
Fig. 3
Fig. 3
Median CD4+ T cell percentages in children aged six to ten years of age, indexed according to the time of first asthma medication use (Time 0). The slope estimates of CD4+ cell percent from the mixed model analysis are annotated in the upper portion of the graph.
See this image and copyright information in PMC

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