title: Clinical Characteristics and Lung Function in Older Children Vertically Infected With Human Immunodeficiency Virus in Malawi.
abstract: BACKGROUND
  Antiretroviral therapy (ART) has led to increased survival of children with vertically acquired human immunodeficiency virus infection. Significant morbidity arises from respiratory symptoms, but aetiology and pulmonary function abnormalities have not been systematically studied.
  
  
  METHODS
  Human immunodeficiency virus-positive children aged 8-16 years were systematically recruited within clinics in Blantyre, Malawi. Clinical review, quality of life assessment, spirometry, and chest radiography were performed.
  
  
  RESULTS
  One hundred sixty participants had a mean of age 11.1 (range, 8-16) years and 50.0% were female. Cough was present in 60 (37.5%) participants, and 55 (34.4%) had moderate or severe dyspnoea. Thirty-four (22.1%) participants had digital clubbing. Thirty-three (20.6%) participants were hypoxic at rest. One hundred eighteen (73.8%) of the children were receiving ART; median CD4 count was 698 cells/µL in these compared with 406 cells/µL in ART-naive individuals (P < .001). From 145 spirometry traces (90.6%), mean forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were 1.06 and 0.89 standard deviations below predicted mean, respectively. Twenty-one (14.5%) traces demonstrated obstructive defects and 26 (17.9%) reduced FVC. Lung function abnormality was not associated with any clinical findings. Of the 51 individuals with abnormal lung function, the mean increase in FEV1 after salbutamol was 3.8% (95% confidence interval, 0.02-7.53). "Tramlines" and ring shadows were seen on chest radiographs in over half of cases.
  
  
  CONCLUSIONS
  Symptoms of chronic lung disease were highly prevalent with 2 main clinical phenotypes: "cough" and "hypoxia". Lung function abnormalities are common, poorly responsive to bronchodilators, and apparent throughout the age range of our cohort. Pathological causes remain to be elucidated. Cough and hypoxic phenotypes could be a useful part of diagnostic algorithms if further validated.
authors.affiliation: College of Medicine, University of Malawi London School of Hygiene & Tropical Medicine, United Kingdom.
authors.forename: Thandie
authors.initials: T
authors.lastname: Mwalukomo
authors.affiliation: College of Medicine, University of Malawi.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Rylance
authors.affiliation: London School of Hygiene & Tropical Medicine, United Kingdom.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Webb
authors.affiliation: Medical Research Council Unit, Gambia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Anderson
authors.affiliation: College of Medicine, University of Malawi University of St Andrews, United Kingdom.
authors.forename: Bernadette
authors.initials: B
authors.lastname: O'Hare
authors.affiliation: College of Medicine, University of Malawi Dignitas International, Zomba, Malawi.
authors.forename: Joep J
authors.initials: JJ
authors.lastname: van Oosterhout
authors.affiliation: London School of Hygiene & Tropical Medicine, United Kingdom.
authors.forename: Rashida A
authors.initials: RA
authors.lastname: Ferrand
authors.affiliation: College of Medicine, University of Malawi London School of Hygiene & Tropical Medicine, United Kingdom.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Corbett
authors.affiliation: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre Liverpool School of Tropical Medicine, United Kingdom.
authors.forename: Jamie
authors.initials: J
authors.lastname: Rylance
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D003371:Cough / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000503:physiopathology* / Q000635:transmission*; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D018445:Infectious Disease Transmission, Vertical; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008295:Malawi; D008297:Male; D011788:Quality of Life; D013902:Radiography, Thoracic; D012120:Respiration Disorders / Q000188:drug therapy / Q000209:etiology*; D012307:Risk Factors; D013147:Spirometry
chemical_list: D019380:Anti-HIV Agents; D001993:Bronchodilator Agents
keywords: HIV; case definition; chronic lung disease; infectious disease transmission; respiratory function tests; vertical