Shearer William T, Jacobson Denise L, Yu Wendy, Siberry George K, Purswani Murli, Siminski Suzanne, Butler Laurie, Leister Erin, Scott Gwendolyn, Van Dyke Russell B, Yogev Ram, Paul Mary E, Puga Ana, Colin Andrew A, Kattan Meyer
Department of Pediatrics, Baylor College of Medicine, and the Department of Allergy and Immunology, Texas Children's Hospital, Houston, Tex.
Department of Biostatistics, Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Mass.
J Allergy Clin Immunol. 2017 Oct;140(4):1101-1111.e7. doi: 10.1016/j.jaci.2017.01.031. Epub 2017 Mar 6.
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.
We sought to perform objective pulmonary function tests (PFTs) in HIV-infected and HEU youth with and without diagnosed asthma.
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.
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).
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.
与未感染艾滋病毒的暴露儿童（HEU）相比，10至21岁围产期感染艾滋病毒的青少年哮喘发病率和患病率有所增加。
我们试图对已诊断和未诊断哮喘的感染艾滋病毒和HEU青少年进行客观的肺功能测试（PFT）。
通过对13个地点的370名参与者（218名感染艾滋病毒者和152名HEU参与者）进行病历审查和自我报告来确定哮喘。可解释的PFT（188名感染艾滋病毒者和132名HEU参与者）被分类为阻塞性、限制性或正常，并在吸入支气管扩张剂后确定可逆性。测量了HIV-1 RNA、CD4和CD8 T细胞、嗜酸性粒细胞、总IgE、过敏原特异性IgE和尿可替宁的值。相对于HEU参与者，确定了感染艾滋病毒参与者哮喘和PFT结果的调整患病率比（PR），并对年龄、种族/族裔和性别进行了控制。
在218名感染艾滋病毒的参与者中，75名（34%）被确定患有当前哮喘，在152名HEU参与者中，38名（25%）患有当前哮喘（调整PR，1.33；P = 0.11）。阻塞性疾病的患病率在艾滋病毒感染状态方面没有差异。总体而言，感染艾滋病毒的青少年比HEU青少年的可逆性更低（183人中的17人[9%]对126人中的21人[17%]；调整PR，0.47；P = 0.020），在仅具有阻塞性PFT结果的人群中也是如此（调整PR，0.46；P = 0.016）。在患有当前哮喘的感染艾滋病毒的青少年中，血清IgE水平与CD8 T细胞计数呈负相关，与嗜酸性粒细胞计数呈正相关，与CD4 T细胞计数无关。与HEU参与者相比，感染艾滋病毒的青少年特定IgE水平与几种吸入性和食物过敏原的关联较低，且CD4/CD8 T细胞比率显著较低（表明免疫失衡）。
与HEU青少年相比，感染艾滋病毒的青少年阻塞性肺病的可逆性降低，这在哮喘中并不典型。这可能表明是慢性阻塞性肺疾病的早期阶段。有必要对其进行成年期随访，以进一步确定他们的肺部结局。
