title: Long-term pulmonary complications in perinatally HIV-infected youth.
abstract: BACKGROUND
  Increased incidence and prevalence of asthma have been documented for perinatally HIV-infected youth 10 to 21 years of age compared with HIV-exposed uninfected (HEU) youth.
  
  
  OBJECTIVE
  We sought to perform objective pulmonary function tests (PFTs) in HIV-infected and HEU youth with and without diagnosed asthma.
  
  
  METHODS
  Asthma was determined in 370 participants (218 HIV-infected and 152 HEU participants) by means of chart review and self-report at 13 sites. Interpretable PFTs (188 HIV-infected and 132 HEU participants) were classified as obstructive, restrictive, or normal, and reversibility was determined after bronchodilator inhalation. Values for HIV-1 RNA, CD4 and CD8 T cells, eosinophils, total IgE, allergen-specific IgE, and urinary cotinine were measured. Adjusted prevalence ratios (PRs) of asthma and PFT outcomes were determined for HIV-infected participants relative to HEU participants, controlling for age, race/ethnicity, and sex.
  
  
  RESULTS
  Current asthma was identified in 75 (34%) of 218 HIV-infected participants and 38 (25%) of 152 HEU participants (adjusted PR, 1.33; P = .11). The prevalence of obstructive disease did not differ by HIV status. Reversibility was less likely in HIV-infected youth than in HEU youth (17/183 [9%] vs 21/126 [17%]; adjusted PR, 0.47; P = .020) overall and among just those with obstructive PFT results (adjusted PR, 0.46; P = .016). Among HIV-infected youth with current asthma, serum IgE levels were inversely correlated with CD8 T-cell counts and positively correlated with eosinophil counts and not associated with CD4 T-cell counts. HIV-infected youth had lower association of specific IgE levels to several inhalant and food allergens compared with HEU participants and significantly lower CD4/CD8 T-cell ratios (suggesting immune imbalance).
  
  
  CONCLUSIONS
  Compared with HEU youth, HIV-infected youth demonstrated decreased reversibility of obstructive lung disease, which is atypical of asthma. This might indicate an early stage of chronic obstructive pulmonary disease. Follow-up into adulthood is warranted to further define their pulmonary outcomes.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, and the Department of Allergy and Immunology, Texas Children's Hospital, Houston, Tex. Electronic address: wtsheare@texaschildrens.org.
authors.forename: William T
authors.initials: WT
authors.lastname: Shearer
authors.affiliation: Department of Biostatistics, Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Mass.
authors.forename: Denise L
authors.initials: DL
authors.lastname: Jacobson
authors.affiliation: Department of Biostatistics, Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Mass.
authors.forename: Wendy
authors.initials: W
authors.lastname: Yu
authors.affiliation: Maternal Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md.
authors.forename: George K
authors.initials: GK
authors.lastname: Siberry
authors.affiliation: Bronx Lebanon Hospital Center, New York, NY.
authors.forename: Murli
authors.initials: M
authors.lastname: Purswani
authors.affiliation: Frontier Science & Technology Research Foundation, Amherst, NY.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Siminski
authors.affiliation: Frontier Science & Technology Research Foundation, Amherst, NY.
authors.forename: Laurie
authors.initials: L
authors.lastname: Butler
authors.affiliation: Department of Biostatistics, Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Mass.
authors.forename: Erin
authors.initials: E
authors.lastname: Leister
authors.affiliation: Department of Pediatrics, Clinical Research Division, University of Miami Miller School of Medicine, Miami, Fla.
authors.forename: Gwendolyn
authors.initials: G
authors.lastname: Scott
authors.affiliation: Section of Infectious Diseases, Department of Pediatrics, Tulane Medical Center, New Orleans, La.
authors.forename: Russell B
authors.initials: RB
authors.lastname: Van Dyke
authors.affiliation: Pediatric Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Ram
authors.initials: R
authors.lastname: Yogev
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, and Department of Retrovirology, Texas Children's Hospital, Houston, Tex.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Paul
authors.affiliation: Pediatric Infectious Disease, Children's Diagnostic & Treatment Center, Fort Lauderdale, Fla.
authors.forename: Ana
authors.initials: A
authors.lastname: Puga
authors.affiliation: Division of Pediatric Pulmonary, Batchelor Research Institute, Miami, Fla.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Colin
authors.affiliation: Division of Pediatric Pulmonology, Columbia University Medical Center, New York, NY.
authors.forename: Meyer
authors.initials: M
authors.lastname: Kattan
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000453:epidemiology / Q000276:immunology*; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D004804:Eosinophils / Q000276:immunology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000276:immunology*; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D007073:Immunoglobulin E / Q000378:metabolism; D015994:Incidence; D008297:Male; D018811:Maternal Exposure / Q000009:adverse effects; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology / Q000276:immunology*; D015995:Prevalence; D012129:Respiratory Function Tests; D013997:Time Factors; D014481:United States; D019562:Viral Load
chemical_list: D007073:Immunoglobulin E
keywords: Pediatric HIV infection; asthma; asthma-COPD overlap syndrome; chronic obstructive pulmonary disease; immune imbalance (T(H)2 shift); obstructive and restrictive pulmonary disease; pulmonary complications of HIV infection; pulmonary function testing; reversibility of obstructive air flow with bronchodilators