title: Clinical and immunological correlates of chest X-ray abnormalities in HIV-infected South African children with limited access to anti-retroviral therapy.
abstract: BACKGROUND
  The chest X-ray (CXR) abnormalities of human immunodeficiency virus (HIV)-infected children in low/middle income countries (LMIC's) have not been well studied.
  
  
  OBJECTIVE
  To describe the CXR abnormalities and associated clinical/immunological features in HIV-infected South African children.
  
  
  METHODS
  A prospective study of HIV-infected children who underwent baseline chest radiography and clinical and immunological HIV-staging. CXR abnormalities were stratified as grade 1 (mild) or grade 2 (moderate/severe). Univariate and multiple logistic regression analyses assessed associations between radiological severity and clinical/immunological parameters.
  
  
  RESULTS
  Three hundred thirty children (53% male), median age 23.8 months, were included; 303 (92%) had moderate/severe clinical disease and 225 (68%) moderate/severe immune suppression; 52 (16%) had a normal CXR; 169 (51%) had grade 2 CXR abnormalities, manifesting as: confluent opacification (n = 91, 28%), nodules (n = 37, 11%), or nodules with opacification (n = 41, 12%) Grade 2 abnormality was associated with more advanced clinical HIV disease (OR: 6.9; 95% CI: 1.9-25.6), CD4+ less than 20% (OR: 1.8; 95% CI: 1.0-3.0) and age over 24 months (OR: 4.1; 95% CI: 2.1-8.0).
  
  
  CONCLUSIONS
  CXR abnormalities are common in HIV-infected children in LMIC's. The extent of radiological abnormality correlates with age and clinical and immunological severity of HIV-disease.
authors: Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa.
authors: Richard D
authors: RD
authors: Pitcher
authors: Carl
authors: C
authors: Lombard
authors: Mark F
authors: MF
authors: Cotton
authors: Stephen J
authors: SJ
authors: Beningfield
authors: Heather J
authors: HJ
authors: Zar
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000276:immunology; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012140:Respiratory Tract Diseases / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000276:immunology; D012307:Risk Factors; D012720:Severity of Illness Index; D013019:South Africa; D014965:X-Rays
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV infection; chest X-ray features; children