Persistent and chronic lung disease in HIV-1 infected and uninfected African children.
OBJECTIVE
The causes of persistent lung disease (PLD) and chronic lung disease (CLD) are unknown in HIV-infected children in developing countries. We describe the causes and course of PLD and CLD in HIV-infected and uninfected children.


METHODS
Of 194 children with lung disease persisting for at least 1 month who were seen at the paediatric respiratory clinic over a 2-year period, 42 underwent invasive investigations after failed initial management over 3 months. PLD was defined as the presence of clinical and radiological features of lung disease for more than 1 month, and CLD as these features for more than 3 months.


RESULTS
One hundred and thirty-eight (71%) of the 194 children with PLD were HIV-infected, 52 (27%) were not infected and four (2%) were of undetermined HIV status. Forty-eight per cent of the HIV-infected children and 52% of the HIV-uninfected children responded to initial treatment over 3 months; the presumptive diagnoses in these were tuberculosis, interstitial pneumonitis, bronchiectasis and post-ventilation lung syndrome. Of the 28 HIV-infected children with CLD who underwent invasive investigations 16 (57%) had lymphoid interstitial pneumonitis, eight (29%) had tuberculosis and four (14%) had non-specific interstitial pneumonitis. Of the 14 HIV-uninfected children with CLD who had invasive testing there were four cases (29%) each of tuberculosis and interstitial pneumonitis, three (22%) cases of bronchiectasis and one case of each of extrinsic allergic alveolitis, crytogenic fibrosing alveolitis and non-Hodgkin's lymphoma.


CONCLUSIONS
This is the first set of data on the causes of CLD in HIV-infected children in a developing country. Every effort should be made to identify the infectious agent, whether M. tuberculosis or a secondary bacterial infection in LIP, in order to treat most appropriately these children with lung disease.
Department of Paediatrics and Child Health, Faculty of Medicine, University of Natal, Durban, South Africa.
P M
PM
Jeena
H M
HM
Coovadia
S A
SA
Thula
D
D
Blythe
N J
NJ
Buckels
R
R
Chetty
D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008171:Lung Diseases / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology