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Long-Term Pulmonary Complications in Perinatally HIV-Infected Youth.

Long-Term Pulmonary Complications in Perinatally HIV-Infected Youth.
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Shearer WT, Jacobson DL, Yu W, Siberry GK, Purswani M, Siminski S, Butler L, Leister E, Scott G, Van Dyke RB, Yogev R, Paul ME, Puga A, Colin AA, Kattan M, ,


Shearer WT, Jacobson DL, Yu W, Siberry GK, Purswani M, Siminski S, Butler L, Leister E, Scott G, Van Dyke RB, Yogev R, Paul ME, Puga A, Colin AA, Kattan M, , (click to view)

Shearer WT, Jacobson DL, Yu W, Siberry GK, Purswani M, Siminski S, Butler L, Leister E, Scott G, Van Dyke RB, Yogev R, Paul ME, Puga A, Colin AA, Kattan M, ,

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The Journal of allergy and clinical immunology 2017 03 06() pii S0091-6749(17)30336-6
Abstract
BACKGROUND
Increased incidence and prevalence of asthma have been documented for perinatally HIV-infected (HIV) youth 10-21 years of age (youth) compared to HIV-exposed uninfected (HEU) youth.

OBJECTIVE
To perform objective pulmonary function tests (PFTs) in HIV and HEU youth with and without diagnosed asthma.

METHOD
Asthma was determined in 370 participants (218 HIV, 152 HEU) by chart review and self-report at 13 sites. Interpretable PFTs (188 HIV, 132 HEU) were classified as obstructive, restrictive, or normal and reversibility was determined after bronchodilator inhalation. HIV-1 RNA, CD4 and CD8 T-cells, eosinophils, total IgE, allergen-specific IgE, and urinary cotinine were measured. Adjusted prevalence ratios (aPR) of asthma and PFT outcomes were determined for HIV relative to HEU controlling for age, race/ethnicity and sex.

RESULTS
Current asthma was identified in 75/218 (34%) HIV and 38/152 (25%) HEU (aPR=1.33, p=0.11). Prevalence of obstructive disease did not differ by HIV status. Reversibility was less likely in HIV youth than in HEU (17/183 (9%) vs. 21/126 (17%), (aPR=0.47, p=0.020) overall and among just those with OBS (aPR=0.46, p=0.016). Among HIV youth with current asthma, serum IgE levels were inversely correlated with CD8 T-cell, and positively correlated with eosinophil counts, and not associated with CD4 T-cells. HIV youth had lower association of specific IgE to several inhalant and food allergens compared to HEU and significantly lower CD4/CD8 T-cell ratios (suggesting immune imbalance).

CONCLUSION
Compared to HEU, HIV youth demonstrated decreased reversibility of obstructive lung disease, atypical of asthma. This may indicate an early stage of chronic obstructive pulmonary disease. Follow-up into adulthood is warranted to further define their pulmonary outcomes.

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