Chronic Lung Disease in Adolescents With Delayed Diagnosis of Vertically Acquired HIV Infection
Chronic Lung Disease in Adolescents With Delayed Diagnosis of Vertically Acquired HIV Infection
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DOI：
10.1093/cid/cis271
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发表时间：
2012-07-01
影响因子：
11.8
通讯作者：
Corbett, Elizabeth L.
中科院分区：
文献类型：
--
作者：
Ferrand, Rashida A.;Desai, Sujal R.;Corbett, Elizabeth L.
背景。在非洲，大量垂直获得性人类免疫缺陷病毒（HIV）感染的长期幸存者正进入青春期，并且面临着延迟诊断和未经治疗的艾滋病毒感染慢性并发症的高风险。慢性呼吸道症状比根据艾滋病毒文献预期的更为常见。方法。连续招募了在津巴布韦哈拉雷 2 个 HIV 护理诊所就诊的疑似垂直感染 HIV 的青少年，并通过临床病史和检查、CD4 计数、肺功能测试、多普勒超声心动图和胸部 X 光检查 (CXR) 进行评估。使用高分辨率计算机断层扫描 (HRCT) 对疑似非结核性慢性肺病 (CLD) 的患者进行扫描。结果。在 116 名参与者中（43% 为男性；平均年龄为 14 +/- 2.6 岁，艾滋病毒诊断时的平均年龄为 12 岁），69% 正在接受抗逆转录病毒治疗。分别有 66% 和 21% 的参与者报告有慢性咳嗽和运动耐量降低； 41% 的人在前一年报告过多次呼吸道感染，10% 的人患有杵状指。超过 40% 的人在休息时 (13%) 或运动时 (29%) 出现低氧血症，7% 的人患有肺动脉高压（平均肺动脉压 >25 mm Hg）。未经选择的青少年诊所参加者中 40% 的 1 秒用力呼气量 (FEV1) 符合严重缺氧 CLD 的标准。这种情况在休息时并不明显。目前病因、预后和治疗反应尚不清楚。
Background. Long-term survivors of vertically acquired human immunodeficiency virus (HIV) infection are reaching adolescence in large numbers in Africa and are at high risk of delayed diagnosis and chronic complications of untreated HIV infection. Chronic respiratory symptoms are more common than would be anticipated based on the HIV literature.Methods. Consecutive adolescents with presumed vertically acquired HIV attending 2 HIV care clinics in Harare, Zimbabwe, were recruited and assessed with clinical history and examination, CD4 count, pulmonary function tests, Doppler echocardiography, and chest radiography (CXR). Those with suspected nontuberculous chronic lung disease (CLD) were scanned using high-resolution computed tomography (HRCT).Results. Of 116 participants (43% male; mean age, 14 +/- 2.6 years, mean age at HIV diagnosis, 12 years), 69% were receiving antiretroviral therapy. Chronic cough and reduced exercise tolerance were reported by 66% and 21% of participants, respectively; 41% reported multiple respiratory tract infections in the previous year, and 10% were clubbed. More than 40% had hypoxemia at rest (13%) or on exercise (29%), with pulmonary hypertension (mean pulmonary artery pressure >25 mm Hg) in 7%. Forced expiratory volume in 1 second (FEV1) was 40% of unselected adolescent clinic attendees meeting criteria for severe hypoxic CLD. This condition is not obvious at rest. Etiology, prognosis, and response to treatment are currently unknown.