Pediatric Infectious Disease

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VOLUME 1 , ISSUE 2 ( April-June, 2019 ) > List of Articles

Original Article

Bronchiectasis in Pediatric HIV Infection: An Indian Perspective

GN Sanjeeva, Kani Varshneya, HB Pavithra, RL Ramesh, Thomas Semple, Catherine M Owens, Samatha Sonnappa

Keywords : Bronchiectasis, FEV1, HIV-infected children, Risk factors

Citation Information : Sanjeeva G, Varshneya K, Pavithra H, Ramesh R, Semple T, Owens CM, Sonnappa S. Bronchiectasis in Pediatric HIV Infection: An Indian Perspective. Pediatr Inf Dis 2019; 1 (2):45-51.

DOI: 10.5005/jp-journals-10081-1204

License: CC BY-NC 4.0

Published Online: 01-12-2016

Copyright Statement:  Copyright © 2019; The Author(s).


Background: Children with vertically acquired HIV-infection (CLHIV) surviving into adulthood are susceptible to sequelae such as chronic lung disease (CLD) including bronchiectasis. Our objective was to characterize bronchiectasis radiologically and functionally, estimate prevalence, and determine risk factors in Indian CLHIV. Meterials and methods: In this prospective cross-sectional study, CLHIV aged 5–18 years were categorized into either high-resolution computed tomography (HRCT) confirmed bronchiectasis or control groups without clinical evidence of CLD. Clinical and radiological evaluations, chart review, spirometry, and 6-minute walk test (6MWT) were performed. Baseline characteristics of both groups were compared using Mann–Whitney U or Chi-square, or t tests. Multivariable logistic regression was used to determine factors independently associated with bronchiectasis. Findings: Four hundred and eleven CLHIV with median (IQR) age 12 years (9.5–14.5) were screened. Thirty-nine (10.6%) children had bronchiectasis and 160 with no CLD were controls. Mean ± SD of zFEV1 (−2.61 ± 0.9) and zFVC (−2.0 ± 0.8) in the bronchiectasis group was significantly lower than that of control group (zFEV1 = −0.37 ± 0.87; zFVC = −0.55 ± 0.88). During 6MWT, 41% in the bronchiectasis group desaturated (Chi-square = 6.19; p = 0.01) as compared to 20% in control group and 76% covered <3rd centile distance (Chi-square = 3.95; p = 0.047) as compared to 57% in control group. Age >5 years (OR-3.39; 95% CI [1.30, 8.87]) at HIV-diagnosis and recurrent sinopulmonary infections (OR-2.37; 95% CI [1.07, 5.24]) were found to be independent risk factors for the development of bronchiectasis. Interpretation: Bronchiectasis was seen in 9.5% of our cohort of CLHIV causing significantly abnormal pulmonary function. Late HIV diagnosis (age >5 years) and recurrent sinopulmonary infections were independent risk factors for developing bronchiectasis.

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  1. Ferrand RA, Luethy R, Bwakura F, et al. HIV infection presenting in older children and adolescents: a case series from Harare, Zimbabwe. Clin Infect Dis 2007;44(6):874–878. DOI: 10.1086/511878.
  2. National AIDS Control Organisation (NACO). Annual Report 2016. Available from: (accessed on January 10, 2017).
  3. Rajasekaran S, Jeyaseelan L, Raja K, et al. Demographic & clinical profile of HIV infected children accessing care at Tambaram, Chennai, India. Indian J Med Res 2009;129(1):42–49.
  4. Sanjeeva GN, Sukanya V, Shivananda GM. Clinical profile, treatment response, and outcome of HIV-TB co-infected children. Pediatr Infect Dis J 2013;5:3–8. DOI: 10.1016/
  5. Callahan CW, Redding GJ. Bronchiectasis in children: orphan disease or persistent problem? Pediatr Pulmonol 2002;33(6):492–496. DOI: 10.1002/ppul.10104.
  6. Khadilkar VV, Khadilkar AV, Cole TJ, et al. Crosssectional growth curves for height, weight and body mass index for affluent Indian children, 2007. Indian Pediatr 2009;46(6):477–489.
  7. Central Tuberculosis Division. National guideline for partnership, Revised National Tuberculosis Control Programme. 2014. Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. Available from: (accessed June 9, 2016).
  8. Ferrand RA, Desai SR, Hopkins C, et al. Chronic lung disease in adolescents with delayed diagnosis of vertically acquired HIV infection. Clin Infect Dis 2012;55(1):145–152. DOI: 10.1093/cid/cis271.
  9. Wormanns D, Hamer OW. [Glossary of terms for thoracic Imaging–German version of the fleischner Society recommendations]. [Article in German]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2015;187(8):638–661. DOI: 10.1055/s-0035-1553216.
  10. Pasteur MC, Bilton D, Hill AT. British thoracic society bronchiectasis non-CF guideline group. British thoracic society guideline for non-CF bronchiectasis. Thorax 2010;65:1–58. DOI: 10.1136/thx.2010.136119.
  11. Pitcher RD, Lombard CJ, Cotton MF, et al. Chest radiographic abnormalities in HIV-infected African children: a longitudinal study. Thorax 2015;70(9):840–846. DOI: 10.1136/thoraxjnl-2014-206105.
  12. Kirkby J, Welsh L, Lum S, et al. The EPICure study: comparison of pediatric spirometry in community and laboratory settings. Pediatr Pulmonol 2008;43(12):1233–1241. DOI: 10.1002/ppul.20950.
  13. Quanjer PH, Stanojevic S, Cole TJ, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J 2012;40(6):1324–1343. DOI: 10.1183/09031936.00080312.
  14. Kirkby J, Lum S, Stocks J, et al. Adaptation of the GLI- 2012 spirometry reference equations for use in Indian children. European Respiratory Society 2014;44:191.
  15. ATS Statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2016;193(10):1185. DOI: 10.1164/rccm.19310erratum.
  16. Ulrich S, Hildenbrand FF, Treder U, et al. Reference values for the 6-minute walk test in healthy children and adolescents in Switzerland. BMC Pulm Med 2013;13:49. DOI: 10.1186/1471-2466-13-49.
  17. Berman DM, Mafut D, Djokic B, et al. Risk factors for the development of bronchiectasis in HIV-infected children. Pediatr Pulmonol 2007;42(10):871–875. DOI: 10.1002/ppul.20668.
  18. Sheikh S, Madiraju K, Steiner P. Bronchiectasis in pediatric AIDS. Chest 1997;112(5):1202–1207. DOI: 10.1378/chest.112.5.1202.
  19. Perera PL, Screaton NJ. Radiological features of bronchiectasis. Eur Respir Mon 2011;52:44–67. Available from: (accessed on January 10, 2017). DOI: 10.1183/1025448x.10003510.
  20. Rossi SE, Franquet T, Volpacchio M, et al. Tree-in-bud pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics 2005;25(3):789–801. DOI: 10.1148/rg.253045115.
  21. Weber HC, Gie RP, Wills K, et al. Clinical features and lung function in HIV-infected children with chronic lung disease. S Afr J Child Health 2015;9(3):72–75. DOI: 10.7196/SAJCH.7940.
  22. Masekela R, Anderson R, Moodley T, et al. HIV-related bronchiectasis in children: an emerging spectre in high tuberculosis burden areas. Int J Tuberc Lung Dis 2012;16(1):114–119. DOI: 10.5588/ijtld.11.0244.
  23. Chang AB, Grimwood K, Maguire G, et al. Management of bronchiectasis and chronic suppurative lung disease in indigenous children and adults from rural and remote Australian communities. Med J Aust 2008;189(7):386–393. DOI: 10.5694/j.1326-5377.2008.tb02085.x.
  24. McGuinness G, Naidich DP, Garay S, et al. AIDS associated bronchiectasis: CT features. J Comput Assist Tomogr 1993;17(2): 260–266. DOI: 10.1097/00004728-199303000-00015.
  25. Holmes AH, Trotman-Dickenson B, Edwards A, et al. Bronchiectasis in HIV disease. Q J Med 1992;85(307–308):875–882.
  26. Cole PJ. Inflammation: a two-edged sword–the model of bronchiectasis. Eur J Respir Dis Suppl 1986;147:6–15.
  27. National AIDS Control Organisation (NACO). Pediatric Antiretroviral Therapy (ART) Guidelines, 2013. Available from: (accessed June 9, 2016).
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