Chronic radiographic lung changes in children with vertically transmitted HIV-1 infection.
OBJECTIVE
We prospectively studied children with and without maternally transmitted HIV-1 infection born to mothers infected with HIV-1 to determine the incidence of chronic radiographic lung changes (CRC) and to correlate these changes with clinical assessments.


METHODS
Between 1990 and 1997, we scored 3050 chest radiographs using a standardized form. Group I children (n = 201) were HIV-1-infected at enrollment. Group II children (n = 512) were enrolled prenatally or before 28 days postpartum and subsequently subdivided into group IIa (n = 86), children identified as HIV-1-infected; and group IIb (n = 426), those who were HIV-1-uninfected. CRC were defined as parenchymal consolidations or nodular disease lasting 3 months or more or increased bronchovascular markings or reticular densities lasting 6 months or more. Morbidity was assessed by CD4 counts, viral load, the presence of low oxygen saturation, wheezing, tachypnea, crackles, and clubbing.


RESULTS
The cumulative incidence of chronic radiographic lung changes in HIV-1-infected children was 32.8% by 4 years old, with increased bronchovascular markings or reticular densities being most common. Chronic changes were associated with lower CD4 cell counts and higher viral loads. Resolution of these chronic changes was associated with decreasing CD4 cell counts but not with lower rates of clinical findings, viral load, or difference in survival.


CONCLUSIONS
With increased survival, CRC are becoming more common. The resolution of these changes may indicate immunologic deterioration rather than clinical improvement.
Norton
K I
KI
Department of Radiology, Mount Sinai School of Medicine, One Gustave Levy Pl., New York, NY 10029, USA.
Kattan
M
M
Rao
J S
JS
Cleveland
R
R
Trautwein
L
L
Mellins
R B
RB
Berdon
W
W
Boechat
M I
MI
Wood
B
B
Meziane
M
M
Platzker
A C
AC
D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000000981:diagnostic imaging / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D015994:Incidence; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D008168:Lung / Q000000981:diagnostic imaging*; D008171:Lung Diseases / Q000000981:diagnostic imaging*; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011859:Radiography; D013997:Time Factors