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.
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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