Department of Diagnostic Radiology, University of Stellenbosch, Cape Town, South Africa.
Department of Paediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Pediatr Pulmonol. 2019 Nov;54(11):1765-1773. doi: 10.1002/ppul.24450. Epub 2019 Jul 24.
Chronic lung disease is common in perinatally HIV-infected children as they increasingly surviving into adolescence. There are few data on the radiologic spectrum of disease in this population.
Contrasted high-resolution computed tomography (HRCT) was performed in ambulatory South African adolescents enrolled in a prospective study of perinatally-infected adolescents aged 9 to 14 years established on combined antiretroviral therapy (cART) and followed for 36 months. Consecutive participants with reduced lung function (defined by a forced expiratory volume in 1 second [FEV1] of <80% normal and/or lung diffusion capacity [DLCO] <80% normal] underwent HRCT. History, clinical, and laboratory data were collected. Two radiologists blinded to clinical data and to each other, reported scans using standardized methodology; a third radiologist resolved discrepancies.
Amongst 100 participants undergoing HRCT, median age was 13.8 years (12.8-15.1). The median duration on cART was 8.4 years (IQR = 5.7-9.8). Mosaic attenuation was the most common finding (73%). Of these 71 (91%) demonstrated associated air trapping radiologically consistent with bronchiolitis obliterans. Bronchiectasis occurred in 39% with significant correlation between extent of bronchiectasis and mosaic attenuation (r = 0.57, P < .001). Prior hospitaliszation for childhood pneumonia at any time before enrollment was associated with mosaic attenuation (OR = 3.9, 95%CI, [1.2-12.5]); prior pulmonary tuberculosis (TB) was associated with the combination of mosaic attenuation and bronchiectasis (OR = 4.9, 95%CI, [1.6-15.7]). Most participants (86%) with mosaic attenuation had stage III or IV HIV disease at time of HIV diagnosis (OR = 3.6; [0.9-14.9]). Inter observer agreement between the two readers was good for bronchiectasis (K = 0.71) and moderate for mosaic attenuation (K = 0.51).
Despite well-controlled HIV and long duration of cART, HRCT changes were common in perinatally HIV-infected adolescents. There was a high prevalence of small airways disease with and without associated bronchiectasis. These changes were associated with prior pulmonary TB or prior severe pneumonia. Strategies to prevent and treat early life respiratory infection must be strengthened to reduce the burden of chronic lung disease in HIV-infected adolescents.
慢性肺部疾病在围产期感染艾滋病毒的儿童中很常见，因为他们越来越能存活到青春期。在这个人群中，关于疾病的放射学谱的数据很少。
在南非门诊进行了对比增强高分辨率计算机断层扫描（HRCT），这项研究纳入了 9 至 14 岁的接受过联合抗逆转录病毒治疗（cART）的围产期感染青少年，他们参与了一项前瞻性研究，并随访了 36 个月。对肺功能下降的连续参与者（定义为第一秒用力呼气量[FEV1]低于正常的 80%和/或肺扩散能力[DLCO]低于正常的 80%）进行了 HRCT。收集了病史、临床和实验室数据。两位放射科医生对临床数据和彼此的报告进行了盲法评估，并使用标准化方法对扫描进行了报告；第三位放射科医生解决了差异。
在 100 名接受 HRCT 的参与者中，中位年龄为 13.8 岁（12.8-15.1）。中位 cART 治疗时间为 8.4 年（IQR=5.7-9.8）。马赛克衰减是最常见的发现（73%）。其中 71 例（91%）表现出与闭塞性细支气管炎一致的放射学相关空气潴留。支气管扩张发生在 39%的患者中，支气管扩张的严重程度与马赛克衰减呈显著相关（r=0.57，P<0.001）。在入组前的任何时候，因儿童肺炎住院治疗与马赛克衰减有关（OR=3.9，95%CI，[1.2-12.5]）；以前的肺结核（TB）与马赛克衰减和支气管扩张的结合有关（OR=4.9，95%CI，[1.6-15.7]）。大多数（86%）有马赛克衰减的参与者在 HIV 诊断时处于 HIV 疾病的 III 或 IV 期（OR=3.6；[0.9-14.9]）。两位放射科医生之间的观察者间一致性对于支气管扩张（K=0.71）和马赛克衰减（K=0.51）都很好。
尽管 HIV 得到了很好的控制，且 cART 的治疗时间很长，但围产期感染艾滋病毒的青少年的 HRCT 变化仍然很常见。小气道疾病的患病率很高，伴有或不伴有相关的支气管扩张。这些变化与以前的肺结核或以前的严重肺炎有关。必须加强预防和治疗生命早期呼吸道感染的策略，以减少艾滋病毒感染青少年慢性肺部疾病的负担。
