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. 2018 Jan 6;66(2):274-281.
doi: 10.1093/cid/cix778.

Human Immunodeficiency Virus-Associated Chronic Lung Disease in Children and Adolescents in Zimbabwe: Chest Radiographic and High-Resolution Computed Tomographic Findings

Sujal R Desai  1 , Arjun Nair  2 , Jamie Rylance  3 , Hilda Mujuru  4 , Kusum Nathoo  4 , Grace McHugh  5 , Edith Majonga  6   5 , John Metcalfe  7 , Katharina Kranzer  6 , Rashida A Ferrand  6   5
Affiliations

Human Immunodeficiency Virus-Associated Chronic Lung Disease in Children and Adolescents in Zimbabwe: Chest Radiographic and High-Resolution Computed Tomographic Findings

Sujal R Desai et al. Clin Infect Dis. .

Abstract

Background: Chronic respiratory symptoms are common among children living with human immunodeficiency virus (HIV). We investigated the radiological features of chronic lung disease in children aged 6-16 years receiving antiretroviral therapy for ≥6 months in Harare, Zimbabwe.

Methods: Consecutive participants from a HIV clinic underwent clinical assessment and chest radiography. Participants with an abnormal chest radiograph (assessed by a clinician) and/or those meeting a clinical case definition for chronic lung disease underwent high-resolution computed tomography (HRCT). Radiological studies were scored independently and blindly by 2 thoracic radiologists. Relationships between radiological abnormalities and lung function were examined.

Results: Among 193 participants (46% female; median age, 11.2 years; interquartile range, 9.0-12.8 years), the median CD4 cell count was 720/µL (473-947/µL), and 79% had a human immunodeficiency virus (HIV) load of <400 copies/mL. The most common chest radiographic finding was ring/tramline opacities (55 of 193 participants; 29%). HRCT scans were evaluated in 84 participants (69%); decreased attenuation (present in 43%) was the dominant abnormality seen. The extent of decreased attenuation was strongly correlated with both the severity and extent of bronchiectasis (rs = 0.68 and P < .001 for both). The extent of decreased attenuation was also negatively correlated with forced expiratory volume in first second of expiration (rs = -0.52), forced vital capacity (rs = -0.42), and forced expiratory flow, midexpiratory phase (rs = -0.42) (P < .001 for all).

Conclusions: The HRCT findings strongly suggest that obliterative bronchiolitis may be the major cause of chronic lung disease in our cohort. Further studies to understand the pathogenesis and natural history are urgently needed.

Keywords: HIV; HRCT; Sub-Saharan Africa; chest X-ray; chronic lung disease.

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Figures

Figure 1.
Figure 1.
Flow chart of study participants. Abbreviations: CXR, chest radiography; HRCT, high-resolution computed tomography; MRC, Medical Research Council; O2, oxygen.
Figure 2.
Figure 2.
A, Chest radiograph of a participant scored as normal independently by both radiologists. B, High-resolution computed tomographic (HRCT) scan of the same patient, through the midzone demonstrating a striking mosaic pattern with areas of decreased attenuation adjacent to regions of normal lung density. C, HRCT scan of another patient, again showing regions of decreased attenuation as part of the mosaic pattern with cylindrical bronchiectasis in the middle lobe.
See this image and copyright information in PMC

References

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