Abstract
RATIONALE: Chronic lung disease is common in adolescents with perinatally acquired HIV (PHIV). HRCT provides delineation of chronic changes. Our aim was to investigate the association of HRCT findings with lung function in PHIV. METHODS: Prospective evaluation of participants in the Cape Town Adolescent Antiretroviral Cohort (CTAAC); perinatally infected YLHIV established on cART. HRCT was performed in participants with abnormal lung function (forced expiratory volume in 1 s [FEV1] of < 80% predicted and/or lung diffusion capacity [DLCO] < 80% predicted) or for clinical symptoms. Spirometry (pre and post bronchodilator) and DLCO (diffusion capacity) was correlated with HRCT findings. RESULTS: There were 100 participants, (median [IQR] age 13.8 (IQR = 12.8, 15.1) years) 46% males. Median age at HIV diagnosis of 3.7 years (IQR = 1.6, 6.9). Median cART duration was 9.9 years (IQR = 7.1;11.5). CD4 count was > 500 cells/mm(3) in 83%. HIV-viral load was < 50 copies/mL in 72%. All participants had abnormal HRCT findings; mosaic attenuation (73/100) was most prevalent. Bronchiectasis occurred in 39/100. Correlation was found between the extent of mosaic attenuation and reduced FEV(1) (r(s) = -0.5; p < 0.001), consistent with airflow obstruction. Extent of bronchiectasis and reduced FEV(1) (r(s) = -0.5; p < 0.001) were strongly correlated. No correlation found between extent of mosaic attenuation or bronchiectasis and DLCO. Most (90%) patients with mosaic attenuation or bronchiectasis were not bronchodilator responsive. CONCLUSION: Mosaic attenuation and bronchiectasis were the most common abnormality on HRCT. The extent of these changes strongly correlated with reduced FEV(1). The extent of disease on HRCT is useful for inferring functional airway obstruction.