title: Risk Factors for Hypoxia and Tachypnea Among Adolescents With Vertically-acquired HIV in Nairobi.
abstract: Chronic lung diseases are increasingly recognized complications of vertically-acquired HIV among adolescents in sub-Saharan Africa and may manifest with hypoxia or tachypnea. We sought to determine the prevalence of and risk factors for hypoxia and tachypnea among adolescents with vertically-acquired HIV in Nairobi, Kenya.
  
  
  
  We performed a cross-sectional analysis of 258 adolescents with vertically-acquired HIV who were initiating care at the Coptic Hope Center for Infectious Diseases. Adolescents with documented pneumonia were excluded. Hypoxia was defined as resting oxygen saturation ≤92%, and tachypnea was based on the 99th percentile of age-appropriate respiratory rates. Logistic regression models adjusted for demographics, and HIV severity estimated odds ratios for risk of hypoxia and tachypnea associated with potential risk factors.
  
  
  
  Overall, 11% of adolescents had hypoxia and 55% had tachypnea. Advanced HIV [adjusted odds ratio (aOR): 2.41] and low CD4 (aOR: 1.74) were associated with greater hypoxia risk, but confidence intervals (CIs) were wide and included the null (95% CI: 0.93-6.23 and 0.69-4.39, respectively). Low CD4 (aOR: 2.45, 95% CI: 1.39-4.32), current antiretroviral therapy use (aOR: 0.48, 95% CI: 0.27-0.86) and stunted growth (aOR: 3.46, 95% CI: 1.94-6.18) were associated with altered tachypnea risk.
  
  
  
  Hypoxia and tachypnea are common among adolescents with vertically-acquired HIV. There was a suggestion that advanced HIV and low CD4 were associated with greater hypoxia risk. Low CD4, lack of antiretroviral therapy use and stunted growth are risk factors for tachypnea. Our findings highlight the chronic lung disease burden in this population and may inform diagnostic algorithms.
authors.affiliation: From the *Department of Medicine, University of Washington, and †Department of Epidemiology, University of Washington, School of Public Health, Seattle, Washington; ‡Department of Pediatrics and Child Health, University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya; §Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas; ¶Department of Global Health, and ‖International Respiratory and Severe Illness Center, University of Washington, Seattle, Washington; **Coptic Hospital, Coptic Hope Center for Infectious Diseases, Nairobi, Kenya; and ††Department of Internal Medicine, University of Zagazig, Zagazig, Egypt.
authors.forename: Engi F
authors.initials: EF
authors.lastname: Attia
authors.forename: Noel S
authors.initials: NS
authors.lastname: Weiss
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Maleche Obimbo
authors.forename: Christine J
authors.initials: CJ
authors.lastname: McGrath
authors.forename: Anthony
authors.initials: A
authors.lastname: Cagle
authors.forename: T Eoin
authors.initials: TE
authors.lastname: West
authors.forename: Neveen G
authors.initials: NG
authors.lastname: El Antouny
authors.forename: Mena
authors.initials: M
authors.lastname: Attwa
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
authors.forename: Michael H
authors.initials: MH
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D000860:Hypoxia / Q000150:complications / Q000453:epidemiology*; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D007630:Kenya / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D059246:Tachypnea / Q000150:complications / Q000453:epidemiology*