Childhood lung function following perinatal HIV infection and early antiretroviral therapy initiation; a cross-sectional study

Abstract

Despite the introduction of ART, HIV-associated pulmonary complications remain prevalent in children following perinatal HIV infection. In the post-ART era the incidence of opportunistic infections has decreased, however non-infectious complications including diminished lung function are common. It is unclear whether early initiation of ART influences lung function later in life.We performed a cross-sectional study examining pulmonary function tests (PFT) (spirometry, plethysmography, carbon monoxide diffusing capacity) in HIV-unexposed (HU), HIV exposed-uninfected (HEU) and perinatally HIV infected children on early ART (HIV+) recruited from the Cape Town arms of the CHER and IMPAACT 1060 trials. PFT was performed once children could participate (October 2013 to January 2020). Global Lung Initiative reference software was used for Z-standardization of lung function by sex, age and height.In total 394 children (HU n=90, HEU n=162, HIV+ n=142) underwent PFT, median age 8.7 (IQR 7.7–9.8) years. HIV+ had ART initiated at a median age of 17.6 (8.0–36.7) weeks. FEV1, FVC, FEV1/FVC, Z-scores were similar in all groups. Plethysmography demonstrated air-trapping with increased total lung capacity (TLC), functional residual capacity (FRC), residual volume (RV) and RV/TLC Z-scores in HIV+. There were no differences in alveolar volume, however diffusing capacity was increased in HIV+.Our findings indicate that following perinatal HIV infection, early ART may attenuate HIV-associate lung disease and is associated with normal childhood spirometry. However plethysmography demonstrates that small airway dysfunction is more pronounced in HIV+. Longitudinal follow-up is required to assess if these children are at risk of obstructive airway disease later in life.