Small-airway disease and its reversibility in human immunodeficiency virus-infected children on highly active antiretroviral therapy

BACKGROUND: Lung function abnormalities may occur in children with human immunodeficiency virus (HIV) infection. Small-airway disease (SAD) precedes abnormalities in forced expiratory volume in 1 s (FEV 1 ). OBJECTIVE: This study aims to assess the presence and reversibility of SAD in HIV-infected children using the Global Lung Function Initiative standards. METHODS: A cross-sectional study was conducted over 6 months at the Paediatric HIV Clinic of the University of Nigeria Teaching Hospital in Enugu, Southeast Nigeria. Eligible consenting children with HIV infection were recruited. Lung function was measured, and the reversibility of FEV 1 and forced vital capacity (FVC) was assessed at 12% while that of forced expiratory flow between 25% and 75% (FEF 25-75 ) was assessed at 12%, 15%, and 20%. Predictors of abnormal Z-score values were determined by multivariate linear and logistic regressions. Statistically significant values were set at P < 0.05. RESULTS: The mean Z-score for FEV 1 , FVC, and FEF 25-75 was − 2.19, −1.86, and − 1.60, respectively. Most patients (73%) had abnormal FEV 1 , while 52% had abnormal FEF 25-75 . Significant changes in FEV 1 ( P = 0.001) and FEF 25-75 ( P < 0.001) occurred after the bronchodilator response (BDR) test. Of the children whose FEV 1 showed positive BDR, 70.9% had low zFEV 1; 50% had low zFEF 25-75 , while all had low FEV 1. Nutritional status (Z-score for body mass index) was significantly associated with low FEV 1. CONCLUSIONS: Abnormal FEF 25-75 as a marker of SAD and FEV 1 with a positive BDR are common in HIV-infected children. These lung function abnormalities justify long-term follow-up for these patients.