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Comley‐White N, Ntsiea V, Potterton J. An interprofessional model of care for adolescents with perinatal HIV: A qualitative study. Health Sci Rep 2024; 7:e2166. [PMID: 38903660 PMCID: PMC11187938 DOI: 10.1002/hsr2.2166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 03/14/2024] [Accepted: 05/23/2024] [Indexed: 06/22/2024] Open
Abstract
Background and Aims The number of perinatally HIV-infected adolescents (PHIVA) is increasing however many health care systems are not prepared for this population and their health challenges, specifically a model of care (MoC) is lacking. Thus the objective of this study was to develop and propose a MoC for PHIVA. Methods Through a qualitative study design, a MoC was developed and ratified with two focus groups, consisting of PHIVA and healthcare professionals. Results Seven participants were included in each focus group and the following themes were developed: relatable attributes; missing components; implementation and suggestions. Changes were made to the drafts of the MoC in response to the focus group results, leading to the finalisation of a MoC for PHIVA. The MoC focused on the importance of interprofessional health care and addressed the physical sequelae that PHIVA are likely to encounter. A schematic of the MoC was created for the use in general public education. Conclusion It is important that healthcare facilities are equipped to handle the specific needs of PHIVA. The interprofessional MoC developed in this study helps to address the requirements of this population.
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Affiliation(s)
| | - Veronica Ntsiea
- Department of PhysiotherapyUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Joanne Potterton
- Department of PhysiotherapyUniversity of the WitwatersrandJohannesburgSouth Africa
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2
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Lala MM. The 'pulmonary diseases spectrum' in HIV infected children. Indian J Tuberc 2023; 70 Suppl 1:S49-S58. [PMID: 38110260 DOI: 10.1016/j.ijtb.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/16/2023] [Accepted: 09/01/2023] [Indexed: 12/20/2023]
Abstract
Despite advances in diagnostic, therapeutic and preventive strategies for HIV, pulmonary diseases continue to be the major cause of morbidity and mortality in infants and children infected with HIV. With effective programs to prevent perinatal HIV-1 transmission to early diagnosis in infants, we have seen a substantial decline in paediatric HIV incidence. Early initiation of Highly Active Anti-Retroviral Therapy (HAART) in all HIV infected children coupled with consistent use of Pneumocystis prophylaxis in all HIV exposed/infected children under 5 years of age has considerably reduced associated infections overall and respiratory infections in particular. In developing countries already burdened with poverty, malnutrition, suboptimal immunization coverage and limited access to health care and treatment, acute and chronic HIV-associated respiratory disease remain a major cause for concern. Prevention of severe respiratory infections in advanced HIV disease among children consists mostly of rapid and optimal HAART initiation & continuation, preventing severe TB disease with BCG and TB preventive treatment, preventing Pneumocystis jirovecii pneumonia with cotrimoxazole prophylaxis and administering age-appropriate vaccinations and catch-up vaccines as per National Immunization schedule.
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Affiliation(s)
- Mamatha Murad Lala
- Department of Pediatrics, KB Bhabha Hospital, Bandra West, D-9, Park Bay, 295, Vidyanagari Road, Kalina, Santacruz [E], Mumbai, 400098, Maharashtra, India.
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Tesfaye SH, Seboka BT, Sisay D. Spatial patterns and spatially-varying factors associated with childhood acute respiratory infection: data from Ethiopian demographic and health surveys (2005, 2011, and 2016). BMC Infect Dis 2023; 23:293. [PMID: 37147575 PMCID: PMC10163815 DOI: 10.1186/s12879-023-08273-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/22/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND In Ethiopia, acute respiratory infections (ARIs) are a leading cause of morbidity and mortality among children under five years. Geographically linked data analysis using nationally representative data is crucial to map spatial patterns of ARIs and identify spatially-varying factors of ARI. Therefore, this study aimed to investigate spatial patterns and spatially-varying factors of ARI in Ethiopia. METHODS Secondary data from the Ethiopian Demographic Health Survey (EDHS) of 2005, 2011, and 2016 were used. Kuldorff's spatial scan statistic using the Bernoulli model was used to identify spatial clusters with high or low ARI. Hot spot analysis was conducted using Getis-OrdGi statistics. Eigenvector spatial filtering regression model was carried out to identify spatial predictors of ARI. RESULTS Acute respiratory infection spatially clustered in 2011 and 2016 surveys year (Moran's I:-0.011621-0.334486). The magnitude of ARI decreased from 12.6% (95%, CI: 0.113-0.138) in 2005 to 6.6% (95% CI: 0.055-0.077) in 2016. Across the three surveys, clusters with a high prevalence of ARI were observed in the North part of Ethiopia. The spatial regression analysis revealed that the spatial patterns of ARI was significantly associated with using biomass fuel for cooking and children not initiating breastfeeding within 1-hour of birth. This correlation is strong in the Northern and some areas in the Western part of the country. CONCLUSION Overall there has been a considerable decrease in ARI, but this decline in ARI varied in some regions and districts between surveys. Biomass fuel and early initiation of breastfeeding were independent predictors of ARI. There is a need to prioritize children living in regions and districts with high ARI.
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Affiliation(s)
| | - Binyam Tariku Seboka
- School of Public Health, college of health sciences and medicine, Dilla University, Dilla, Ethiopia
| | - Daniel Sisay
- School of Public Health, college of health sciences and medicine, Dilla University, Dilla, Ethiopia
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Liu J, Maleche-Obimbo E, Shanthikumar S, Graham SM. A scoping review of lung function in children and adolescents living with HIV in the era of antiretroviral treatment. Pediatr Pulmonol 2023; 58:1344-1354. [PMID: 36811157 DOI: 10.1002/ppul.26365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/01/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) in children and adolescents remains an important health challenge in many countries and is commonly associated with lung disease. The introduction of antiretroviral therapy (ART) has greatly improved survival but chronic lung disease is a common ongoing challenge. We conducted a scoping review of studies that have reported lung function in school-aged children and adolescents living with HIV. METHODS A systematic literature search was performed by searching Medline, Embase, and PubMed databases, limited to articles published between 2011 and 2021 in English language. Inclusion criteria were studies involving participants living with HIV aged 5-18 years and having spirometry data. The primary outcome was lung function as measured by spirometry. RESULTS Twenty-one studies were included in the review. Most study participants were living in the sub-Saharan African region. The prevalence of reduced forced expiratory volume in 1 s (FEV1 ) ranged from 25.3% to 73% across studies, reduced forced vital capacity (FVC) ranged from 10% to 42% and reduced FEV1 /FVC ranged from 3% to 26%. The mean z-score of FEV1 ranged from -2.19 to -0.73, mean zFEV1 /FVC ranged from -0.74 to 0.2, and mean FVC ranged from -1.86 to -0.63. CONCLUSION There is a high prevalence of lung function impairment in children and adolescents living with HIV, which persists in the ART era. Further studies are needed of interventions that might improve lung function in these vulnerable populations.
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Affiliation(s)
- Jingbo Liu
- Department of Paediatrics, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Australia
| | | | | | - Stephen M Graham
- Department of Paediatrics, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Australia
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
- International Union Against Tuberculosis and Lung Disease, Paris, France
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Baumann U, Schulze Sturm U, Königs C. HIV-Infektion und -Exposition bei Kindern und Jugendlichen. DIE GYNÄKOLOGIE 2022. [PMCID: PMC9748901 DOI: 10.1007/s00129-022-05046-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Ulrich Baumann
- Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Bereich Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, Deutschland
| | - Ulf Schulze Sturm
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
| | - Christoph Königs
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Deutschland
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HIV-Infektion und -Exposition bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 2022; 170:997-1010. [PMID: 36213300 PMCID: PMC9524331 DOI: 10.1007/s00112-022-01614-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/24/2022]
Abstract
Hintergrund Seit 1997 steht mit den antiretroviralen, kombinierbaren Wirkstoffen eine effektive Prävention und Behandlung einer Infektion mit dem „human immunodeficiency virus“ (HIV) zur Verfügung. Fragestellung Was wurde in dieser Zeit durch die Transmissionsprophylaxe und Behandlung der HIV-Infektion bei Kindern in Deutschland erreicht? Material und Methoden Darstellung der Entwicklung der Transmissionsprophylaxe und der epidemiologischen Erhebungen des Robert Koch-Instituts, Darstellung der Arzneimittelentwicklung und der Leitlinien zur antiretroviralen Therapie (ART) bei Kindern und Jugendlichen, Vorstellung von Erhebungen der deutschen Kinder-HIV-Kohorte („German pediatric and adolescent HIV cohort“, GEPIC). Ergebnisse Die Einführung der HIV-Testung Schwangerer hat die regelmäßige ART HIV-positiver Schwangerer und die Einführung von transmissionsmindernden Maßnahmen möglich gemacht. Damit konnte das Risiko der vertikalen Transmission von ca. 30 % auf < 1 % gesenkt werden. Gegenwärtig wird untersucht, ob HIV-exponierte Kinder ohne Risiko gestillt werden können. Die ART bei Kindern hat die Überlebensraten sowie die körperliche und die kognitive Entwicklung HIV-positiver Kinder entscheidend verbessert. Neue Wirkstoffe haben ein günstigeres Nebenwirkungsprofil. In Deutschland konnten die WHO-Ziele, bei 90 % der Kinder eine vollständige Suppression der Viruslast zu erzielen, erreicht werden. Späte Diagnosen sind bei Kindern und Jugendlichen weiterhin mit schweren Infektionen verbunden. Die HIV-Infektion ist weiterhin eine Erkrankung mit Stigma geblieben und wird deswegen meist gegenüber den Kindern und ihrer Umwelt geheim gehalten. Schlussfolgerung Mit der jetzt möglichen Transmissionsprophylaxe und Therapie gelingt es, Transmissionen weitgehend zu verhindern und HIV-positiven Kindern bei frühzeitiger Diagnose ein weitgehend gesundes Leben zu ermöglichen. Das Ziel, dass Kinder ihre Krankheit ohne Angst kennen und nennen können, ist nach wie vor nicht erreicht.
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Potterton J, Strehlau R, Shiau S, Comley-White N, Kuhn L, Yin M, Arpadi S. Evaluation of submaximal endurance in young children living with HIV. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2022; 78:1613. [PMID: 35281781 PMCID: PMC8905455 DOI: 10.4102/sajp.v78i1.1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/09/2021] [Indexed: 11/05/2022] Open
Abstract
Background There is growing concern about the long-term sequelae [a condition which is the consequence of a previous disease or injury] of perinatally acquired human immunodeficiency virus (HIV). Children living with HIV (CLHIV) present with cardiopulmonary impairments and decreased physical activity which may be due to poor endurance. Objectives Our study aimed to investigate the sub-maximal endurance of CLHIV compared to a non-infected comparison group. Methods In this cross-sectional descriptive study 346 CLHIV, between ages five and eleven years, were assessed using the Six Minute Walk Test (6MWT). Blood pressure, heart rate and oxygen saturation were measured pre-test, immediately post-test and five minutes post-test. Clinical and anthropometric data were recorded. Height and weight were assessed using a stadiometer and a digital scale, respectively. Results 175 CLHIV (52% female) and 171 children without HIV (46% female) participated. All children were Black African. The CLHIV all initiated antiretroviral therapy (ART) at a young age (mean 8.7 months, standard deviation 6.7) and their disease was well controlled (viral load < 1000copies/ml). There were no statistically significant differences in submaximal endurance between the two groups (p = 0.831). Age of starting ART and stunted growth were negatively associated (r = -2.8 (p = 0.019) and r = -46.1 (p = 0.027), respectively) with distance walked in the 6MWT by girls living with HIV. Conclusion CLHIV who initiate ART early with well-controlled disease are able to attain submaximal endurance levels similar to their uninfected peers. Clinical implications Endurance and physical activity should be monitored in CLHIV. Submaximal endurance levels may improve with age and biological maturation.
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Affiliation(s)
- Joanne Potterton
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Renate Strehlau
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers University, Piscataway, NJ, United States of America
| | - Nicolette Comley-White
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise Kuhn
- Gertrude H. Sergievsky Centre, Columbia University Irving Medical Center, New York, United States of America
| | - Michael Yin
- Department of Infectious Diseases, Columbia University Irving Medical Center, New York, United States of America
| | - Stephen Arpadi
- Gertrude H. Sergievsky Centre, Columbia University Irving Medical Center, New York, United States of America
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8
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Comley-White N, Potterton J, Ntsiea V. The physical sequelae of growing into adolescence with perinatally acquired HIV: a scoping review. PHYSICAL THERAPY REVIEWS 2022. [DOI: 10.1080/10833196.2022.2026009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nicolette Comley-White
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joanne Potterton
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Gray DM, Owusu SK, van der Zalm MM. Chronic lung disease in children: disease focused use of lung function. CURRENT OPINION IN PHYSIOLOGY 2021. [DOI: 10.1016/j.cophys.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Abotsi RE, Nicol MP, McHugh G, Simms V, Rehman AM, Barthus C, Mbhele S, Moyo BW, Ngwira LG, Mujuru H, Makamure B, Mayini J, Odland JØ, Ferrand RA, Dube FS. Prevalence and antimicrobial resistance profiles of respiratory microbial flora in African children with HIV-associated chronic lung disease. BMC Infect Dis 2021; 21:216. [PMID: 33632144 PMCID: PMC7908671 DOI: 10.1186/s12879-021-05904-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/12/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND HIV-associated chronic lung disease (CLD) is common among children living with HIV (CLWH) in sub-Saharan Africa, including those on antiretroviral therapy (ART). However, the pathogenesis of CLD and its possible association with microbial determinants remain poorly understood. We investigated the prevalence, and antibiotic susceptibility of Streptococcus pneumoniae (SP), Staphylococcus aureus (SA), Haemophilus influenzae (HI), and Moraxella catarrhalis (MC) among CLWH (established on ART) who had CLD (CLD+), or not (CLD-) in Zimbabwe and Malawi. METHODS Nasopharyngeal swabs (NP) and sputa were collected from CLD+ CLWH (defined as forced-expiratory volume per second z-score < - 1 without reversibility post-bronchodilation with salbutamol), at enrolment as part of a randomised, placebo-controlled trial of azithromycin (BREATHE trial - NCT02426112 ), and from age- and sex-matched CLD- CLWH. Samples were cultured, and antibiotic susceptibility testing was conducted using disk diffusion. Risk factors for bacterial carriage were identified using questionnaires and analysed using multivariate logistic regression. RESULTS A total of 410 participants (336 CLD+, 74 CLD-) were enrolled (median age, 15 years [IQR = 13-18]). SP and MC carriage in NP were higher in CLD+ than in CLD- children: 46% (154/336) vs. 26% (19/74), p = 0.008; and 14% (49/336) vs. 3% (2/74), p = 0.012, respectively. SP isolates from the NP of CLD+ children were more likely to be non-susceptible to penicillin than those from CLD- children (36% [53/144] vs 11% [2/18], p = 0.036). Methicillin-resistant SA was uncommon [4% (7/195)]. In multivariate analysis, key factors associated with NP bacterial carriage included having CLD (SP: adjusted odds ratio (aOR) 2 [95% CI 1.1-3.9]), younger age (SP: aOR 3.2 [1.8-5.8]), viral load suppression (SP: aOR 0.6 [0.4-1.0], SA: 0.5 [0.3-0.9]), stunting (SP: aOR 1.6 [1.1-2.6]) and male sex (SA: aOR 1.7 [1.0-2.9]). Sputum bacterial carriage was similar in both groups (50%) and was associated with Zimbabwean site (SP: aOR 3.1 [1.4-7.3], SA: 2.1 [1.1-4.2]), being on ART for a longer period (SP: aOR 0.3 [0.1-0.8]), and hot compared to rainy season (SP: aOR 2.3 [1.2-4.4]). CONCLUSIONS CLD+ CLWH were more likely to be colonised by MC and SP, including penicillin-non-susceptible SP strains, than CLD- CLWH. The role of these bacteria in CLD pathogenesis, including the risk of acute exacerbations, should be further studied.
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Affiliation(s)
- Regina E Abotsi
- Department of Molecular and Cell Biology & Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
- Department of Pharmaceutical Microbiology, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana.
| | - Mark P Nicol
- Division of Infection and Immunity, School of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Victoria Simms
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrea M Rehman
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Charmaine Barthus
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Slindile Mbhele
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Brewster W Moyo
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Lucky G Ngwira
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hilda Mujuru
- Department of Paediatrics, University of Zimbabwe, Harare, Zimbabwe
| | - Beauty Makamure
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Justin Mayini
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Jon Ø Odland
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
- International Research Laboratory for Reproductive Ecotoxicology, The National Research University Higher School of Economics, Moscow, Russia
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Rashida A Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Felix S Dube
- Department of Molecular and Cell Biology & Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Githinji L, Zar HJ. Respiratory Complications in Children and Adolescents with Human Immunodeficiency Virus. Pediatr Clin North Am 2021; 68:131-145. [PMID: 33228928 DOI: 10.1016/j.pcl.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Respiratory complications comprise a large proportion of the burden of mortality and morbidity in children with human immunodeficiency virus (HIV). HIV-associated lower respiratory tract infection (LRTI) has declined in incidence with early diagnosis and use of antiretroviral therapy (ART) but is widespread in areas with limited access to ART. HIV-exposed uninfected infants have a higher risk of LRTI early in life than unexposed infants. Pulmonary tuberculosis (PTB) presenting as acute or chronic disease is common in highly TB endemic areas. Chronic lung disease is common; preceding LRTI, PTB or late initiation of ART are risk factors.
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Affiliation(s)
- Leah Githinji
- Department of Paediatrics and Child Health, South Africa MRC Unit on Child & Adolescent Health, University of Cape Town, Red Cross War Memorial Children's Hospital, ICH Building, Klipfontein Road, Rondebosch 7700, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, South Africa MRC Unit on Child & Adolescent Health, University of Cape Town, Red Cross War Memorial Children's Hospital, ICH Building, Klipfontein Road, Rondebosch 7700, South Africa.
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12
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McCollum ED. Longitudinally Evaluating the Lung Function of Children in Low- and Middle-income Countries: It's About Time. Clin Infect Dis 2020; 70:491-492. [PMID: 30918951 DOI: 10.1093/cid/ciz260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Baltimore, Maryland.,Global Program in Respiratory Sciences, Department of Pediatrics, School of Medicine, Baltimore, Maryland.,Health Systems, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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13
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HIV gp120 Induces the Release of Proinflammatory, Angiogenic, and Lymphangiogenic Factors from Human Lung Mast Cells. Vaccines (Basel) 2020; 8:vaccines8020208. [PMID: 32375243 PMCID: PMC7349869 DOI: 10.3390/vaccines8020208] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 02/07/2023] Open
Abstract
Human lung mast cells (HLMCs) express the high-affinity receptor FcεRI for IgE and are involved in chronic pulmonary diseases occurring at high frequency among HIV-infected individuals. Immunoglobulin superantigens bind to the variable regions of either the heavy or light chain of immunoglobulins (Igs). Glycoprotein 120 (gp120) of HIV-1 is a typical immunoglobulin superantigen interacting with the heavy chain, variable 3 (VH3) region of human Igs. The present study investigated whether immunoglobulin superantigen gp120 caused the release of different classes of proinflammatory and immunoregulatory mediators from HLMCs. The results show that gp120 from different clades induced the rapid (30 min) release of preformed mediators (histamine and tryptase) from HLMCs. gp120 also caused the de novo synthesis of cysteinyl leukotriene C4 (LTC4) and prostaglandin D2 (PGD2) from HLMCs. Incubation (6 h) of HLMC with gp120 induced the release of angiogenic (VEGF-A) and lymphangiogenic (VEGF-C) factors from HLMCs. The activating property of gp120 was mediated through the interaction with IgE VH3+ bound to FcεRI. Our data indicate that HIV gp120 is a viral superantigen, which induces the release of different proinflammatory, angiogenic, and lymphangiogenic factors from HLMCs. These observations could contribute to understanding, at least in part, the pathophysiology of chronic pulmonary diseases in HIV-infected individuals.
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Frigati LJ, Ameyan W, Cotton MF, Gregson CL, Hoare J, Jao J, Majonga ED, Myer L, Penazzato M, Rukuni R, Rowland-Jones S, Zar HJ, Ferrand RA. Chronic comorbidities in children and adolescents with perinatally acquired HIV infection in sub-Saharan Africa in the era of antiretroviral therapy. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:688-698. [PMID: 32359507 DOI: 10.1016/s2352-4642(20)30037-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/27/2020] [Accepted: 01/31/2020] [Indexed: 12/13/2022]
Abstract
Globally, 1·7 million children are living with HIV, of which 90% are in sub-Saharan Africa. The remarkable scale-up of combination antiretroviral therapy has resulted in increasing numbers of children with HIV surviving to adolescence. Unfortunately, in sub-Saharan Africa, HIV diagnosis is often delayed with children starting antiretroviral therapy late in childhood. There have been increasing reports from low-income settings of children with HIV who have multisystem chronic comorbidities despite antiretroviral therapy. Many of these chronic conditions show clinical phenotypes distinct from those in adults with HIV, and result in disability and reduced quality of life. In this Review, we discuss the spectrum and pathogenesis of comorbidities in children with HIV in sub-Saharan Africa. Prompt diagnosis and treatment of perinatally acquired HIV infection is a priority. Additionally, there is a need for increased awareness of the burden of chronic comorbidities. Diagnostic and therapeutic strategies need to be collectively developed if children with HIV are to achieve their full potential.
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Affiliation(s)
- Lisa J Frigati
- SA-MRC Unit on Child and Adolescent Health, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Wole Ameyan
- Department of HIV, Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Mark F Cotton
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Celia L Gregson
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Jacqueline Hoare
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jennifer Jao
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Edith D Majonga
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Martina Penazzato
- Department of HIV, Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Ruramayi Rukuni
- Biomedical Research and Training Institute, Harare, Zimbabwe; Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Heather J Zar
- SA-MRC Unit on Child and Adolescent Health, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Rashida A Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe; Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.
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15
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Quantitative CT analysis for bronchiolitis obliterans in perinatally HIV-infected adolescents-comparison with controls and lung function data. Eur Radiol 2020; 30:4358-4368. [PMID: 32172382 DOI: 10.1007/s00330-020-06789-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/15/2020] [Accepted: 03/03/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare quantitative chest CT parameters in perinatally HIV-infected adolescents with and without bronchiolitis obliterans compared with HIV-uninfected controls and their association with lung function measurements. MATERIALS AND METHODS Seventy-eight (41 girls) HIV-infected adolescents with a mean age of 13.8 ± 1.65 years and abnormal pulmonary function tests in the prospective Cape Town Adolescent Antiretroviral Cohort underwent contrast-enhanced chest CT on inspiration and expiration. Sixteen age-, sex-, and height-matched non-infected controls were identified retrospectively. Fifty-one HIV-infected adolescents (28 girls) displayed mosaic attenuation on expiration suggesting bronchiolitis obliterans. Pulmonary function tests were collected. The following parameters were obtained: low- and high-attenuation areas, mean lung density, kurtosis, skewness, ventilation heterogeneity, lung mass, and volume. RESULTS HIV-infected adolescents showed a significantly higher mean lung density, ventilation heterogeneity, mass, and high- and low-attenuation areas compared with non-infected individuals. Kurtosis and skewness were significantly lower as well. HIV-infected adolescents with bronchiolitis obliterans had a significantly lower kurtosis and skewness compared with those without bronchiolitis obliterans. Lung mass and volume showed the strongest correlations with forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and alveolar volume. Low-attenuation areas below - 950 HU and ventilation heterogeneity showed the strongest correlation with FEV1/FVC (range, - 0.51 to - 0.34) and forced expiratory flow between 25 and 75% of FVC (range, - 0.50 to - 0.35). CONCLUSION Quantitative chest CT on inspiration is a feasible technique to differentiate perinatally HIV-infected adolescents with and without bronchiolitis obliterans. Quantitative CT parameters correlate with spirometric measurements of small-airway disease. KEY POINTS • Perinatally HIV-infected adolescents showed a more heterogeneous attenuation of the lung parenchyma with a higher percentage of low- and high-attenuation areas compared with non-infected patients. • Kurtosis and skewness are able to differentiate between HIV-infected adolescents with and without bronchiolitis obliterans using an inspiratory chest CT. • Quantitative CT parameters of the chest correlate significantly with pulmonary function test. Low-attenuation areas and ventilation heterogeneity are particularly associated with spirometric parameters related to airway obstruction.
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Mukherjee A, Lodha R. Coming of Age: Young Adults with Perinatally Acquired HIV Infection. Indian J Pediatr 2019; 86:214-215. [PMID: 30734892 DOI: 10.1007/s12098-019-02888-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 11/24/2022]
Affiliation(s)
| | - Rakesh Lodha
- Department of Pediatrics, AIIMS, New Delhi, 110029, India.
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