Asthma and blocked lungs in HIV-infected youth

Published online: March 7, 2017

An original article is to be published in The Journal of Allergy and Clinical Immunology (JACI). Shearer and colleagues have investigated the origin of asthma being reported in perinatally HIV-infected youth. Physicians who treat patients living with HIV infection are seeing more problems with asthma. Past studies determined if HIV-infected youth had asthma by seeing if they used asthma medication, or if a doctor said they had asthma. The goal of the study was to see how well the HIV youth breathe with a breathing machine called a spirometer. This test does not rely on someone’s opinion about asthma, but instead relies on the objective data recorded by the spirometer (pulmonary function tests).

There were 188 HIV-infected youth (9-21 years of age), and 132 HIV-exposed uninfected youth (9-21 years of age) enrolled. For pulmonary function test results, patients were instructed to inhale, hold their breath, and then blow out into the tube connected to the spirometer. Pulmonologists examined the recording to see if the lungs were obstructed. Patients were then asked to inhale a medicine that dilates the breathing tubes (bronchodilator), and repeat the same breathing tests. Information was also collected from the clinical records and asthma questionnaires. Certain immunological blood tests were also done. Taken together, these tests could tell us if the child is more likely to develop asthma.

HIV-infected youth were much more likely to have a diagnosis of asthma than HIV-exposed uninfected youth. Most HIV-infected youth who were diagnosed with asthma had airway muscles that did not relax much after the bronchodilator medicine.  Some HIV-exposed uninfected youth also had airway muscles that did not relax well but this was less common than among the HIV-infected youth.  When the airway muscles do not relax after the bronchodilator therapy, the patient may have a lung problem that is different from asthma, but similar to chronic obstructive pulmonary disease (COPD). The lymphocyte subet, CD4 that controls the amount of IgE (the antibody that is involved in allergy) was not optimal in The HIV-infected patients.  This means that the HIV-infected patients did not have normal control of some parts of their immune system, a form of immune dysfunction.

This study indicates that most HIV-infected youth might have a complex disease which is a combination of asthma and chronic obstructive pulmonary disease. Some HIV-infected adults with this complex lung problem have developed severe lung disease. It is not known if HIV youth will have lung problems as they grow older. Given the numbers of HIV-infected youth living throughout the world (2.5 million), long-term follow-up studies, and development of new definitive treatments for this lung problem are critical.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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