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Abstract
Introduction Despite advances in the availability of HIV testing and anti-retroviral treatment (ART), access to early infant diagnosis in resource limited settings remains suboptimal. One third of HIV-infected infants have slow-progressing disease and many present to health care services with chronic symptoms in later childhood.
Aims To describe prevalent respiratory symptoms and parameters in HIV-infected children not yet on ART compared to those established on treatment.
Method Two cohorts of children aged 6–16 years with vertically acquired HIV were enrolled: 1) ART naïve, recruited at the time of diagnosis at primary healthcare clinics; 2) established on ART (for >12 months).
Clinical assessment included; interviewer-administered questionnaire detailing medical history, physical examination, anthropometry, pulse oximetry, modified incremental shuttle walk test, spirometry, HIV viral load (only in those on treatment), CD4 count, sputum analysis if positive WHO tuberculosis screen.
Results We recruited 385 ART naïve children (median age 11.3 years) and 202 children (median age 11.1 years) established on ART for a median of 5.5 years (IQR 2.8–7.5), and 79% with suppressed viral load. Mean BMI for age z-score was higher in the ART treated group (−0.5 vs −0.9, p < 0.05) although mean height-for-age z-score was not (−1.6 vs −1.6, p = 0.85).
Daily cough was reported by 53.2% of children at first diagnosis, compared to 14.9% of ART established children (p < 0.0001). Rates of breathlessness were similar (12.1% vs 14.9%) but significantly more of the ART naïve group were hypoxic at rest (14% vs 1%, p < 0.0001). Similar proportions desaturated during shuttle walk testing (9.7% vs 11.7%) but those established on ART were able to walk a significantly greater distance (median 770 m vs 460 m, p < 0.0001).
The proportion of those with abnormal spirometry was similar (25.6% and 24.3%) in ART naïve and treated groups respectively; most commonly reduced forced vital capacity (16.4% and 20.3%, p = 0.48) rather than obstruction (9.1% and 4%, p = 0.18).
Conclusions Chronic respiratory morbidity is common among HIV-infected older children. ART appears to have a beneficial effect on chronic cough, hypoxia at rest and wasting. Breathlessness, spirometric abnormalities and stunting did not improve despite established treatment with good viral suppression.
