South Africa MRC unit on Child and Adolescent Health, Department of Paediatrics and Child Health Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Division of Paediatric Cardiology, Department of Paediatrics and Child Health Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
J Int AIDS Soc. 2019 Jul;22(7):e25340. doi: 10.1002/jia2.25340.
Antiretroviral therapy (ART) has reduced morbidity and mortality in sub-Saharan Africa, but the burden of coexistent cardiopulmonary disease in perinatally HIV-positive adolescents on antiretroviral therapy (ART) has not been well described. The aim of this study was to investigate the prevalence and associations of cardiopulmonary dysfunction in adolescents with perinatally acquired HIV on ART.
For this cross-sectional analysis, 515 perinatally HIV-positive adolescents ages 9 to 14 years on ART for at least six months, and a comparator group of 110 age-matched HIV-uninfected adolescents were tested between August 2013 and April 2015 using echocardiography, six-minute walk test (6MWT) and spirometry. Those with either abnormal spirometry or abnormal 6MWT and any right or left systolic or diastolic dysfunction or abnormal mean pulmonary arterial pressure were considered as having impaired cardiopulmonary function. Logistic regression was used to investigate determinants of impaired cardiopulmonary function.
Overall, 474 adolescents with perinatally acquired HIV (mean [SD] age, 12 [1.6] years; median [IQR] ART duration, 7 [4.6 to 9.3] years; median [IQR] CD4 count, 712 [571 to 959] cell/mm ) and 109 HIV-uninfected adolescents mean (SD) age 11.8 (1.8) years, had successful cardiac and lung function testing. Impaired cardiopulmonary function was detected in 13% of adolescents with perinatally acquired HIV and 8% of HIV-uninfected adolescents, p = 0.136. Among adolescents with perinatally acquired HIV, those with low tricuspid annular plane systolic excursion (TAPSE) had significantly lower mean FEV , 1.5 L versus 1.6 L, p = 0.011. Height (OR 0.7, 95%CI 0.5 to 0.9), body mass index (OR 0.7, 95%CI 0.5 to 0.9) and past pulmonary tuberculosis (OR 2.3, 95%CI 1.2 to 4.4) were significantly associated with a low cardiopulmonary function.
Despite being on ART, cardiopulmonary dysfunction occurs in an appreciable proportion of perinatally HIV-infected adolescents but no significant difference to uninfected controls. This finding requires further exploration. Factors associated with dysfunction may be amenable to public health interventions to reduce cardiopulmonary disease in this population.
抗逆转录病毒疗法（ART）降低了撒哈拉以南非洲的发病率和死亡率，但在接受抗逆转录病毒治疗（ART）的围生期 HIV 阳性青少年中并存心肺疾病的负担尚未得到很好的描述。本研究的目的是调查接受 ART 的围生期 HIV 阳性青少年心肺功能障碍的患病率和相关性。
这项横断面分析纳入了 515 名年龄在 9 至 14 岁之间、接受至少 6 个月 ART 的围生期 HIV 阳性青少年，以及 110 名年龄匹配的 HIV 未感染青少年作为对照组。研究对象于 2013 年 8 月至 2015 年 4 月期间接受超声心动图、六分钟步行试验（6MWT）和肺量测定检查。如果肺量测定或 6MWT 异常，且任何右或左心室收缩或舒张功能障碍或平均肺动脉压异常，则被认为存在心肺功能受损。使用逻辑回归分析探讨心肺功能受损的决定因素。
总体而言，474 名围生期 HIV 感染的青少年（平均[SD]年龄为 12[1.6]岁；中位[IQR]ART 时间为 7[4.6 至 9.3]年；中位[IQR]CD4 计数为 712[571 至 959]细胞/mm ）和 109 名 HIV 未感染的青少年（平均[SD]年龄为 11.8[1.8]岁）成功进行了心脏和肺功能测试。在接受围生期 HIV 感染的青少年中，13%存在心肺功能受损，在 HIV 未感染的青少年中，8%存在心肺功能受损，p 值为 0.136。在围生期 HIV 感染的青少年中，三尖瓣环平面收缩期位移（TAPSE）较低的青少年的平均 FEV 显著降低，为 1.5L 比 1.6L，p 值为 0.011。身高（比值比 0.7，95%置信区间 0.5 至 0.9）、体重指数（比值比 0.7，95%置信区间 0.5 至 0.9）和既往肺结核（比值比 2.3，95%置信区间 1.2 至 4.4）与心肺功能降低显著相关。
尽管接受了 ART，但在相当一部分围生期 HIV 感染的青少年中仍然存在心肺功能障碍，但与未感染的对照组相比没有显著差异。这一发现需要进一步研究。可能与功能障碍相关的因素可以通过公共卫生干预措施来减少该人群的心肺疾病。
