SEARCHCOHORTpediatrics, pulmonology

cohort·pediatrics, pulmonology, infectious disease, epidemiology, public health·PMC10411792

Prevalence, clinical presentation and factors associated with chronic lung disease among children and adolescents living with HIV in Kenya

PLOS ONE · 8 authors, 7 centres

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TL;DR

This study assessed the prevalence of chronic lung disease (CLD) in 320 children and adolescents with HIV in Kenya, finding it affected about a third and was associated with prior lung infections, delayed treatment, and socio-environmental factors.

Full summary

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A longitudinal cohort study enrolled 320 children and adolescents with HIV (median age 13) in Kenya to determine the prevalence and factors of chronic lung disease (CLD). CLD was defined as having two or more respiratory symptoms/signs at enrolment. The prevalence was 26%, which increased to 34% when including exercise limitation on a six-minute walk test. The study notes that CLD is common across age groups, including children under ten. Limitations include potential selection bias from a single tertiary hospital and reliance on self-reported histories. The findings suggest a simple clinical approach using common symptoms can identify affected individuals for care.

STUDY TYPE

cohort

SPECIALTY

pediatrics

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AI pipeline

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ORIGINAL PAPER

PMC10411792

Prevalence, clinical presentation and factors associated with chronic lung disease among children and adolescents living with HIV in Kenya

PLOS ONE

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ABSTRACT

Abstract Introduction Children and adolescents with HIV (CAHIV) may experience recurrent and severe respiratory disease and are at risk of residual lung sequelae, and long-term morbidity from chronically damaged lungs. With improved survival due to increased access to effective antiretroviral therapy there is an increasing population of CAHIV who require optimal life-long care. Chronic lung disease in CAHIV is an under-recognised problem in African settings. We sought to determine the prevalence, clinical presentation and factors associated with chronic lung disease (CLD) among CAHIV in Kenya. Methods CAHIV aged ≤19 years in care at a public hospital in Nairobi were enrolled into a longitudinal cohort study. Sociodemographic and clinical information were obtained through interview, medical record review, physical examination and six-minute walk test. CD4 counts and viral load were determined. Enrolment data was analysed to determine baseline sociodemographic and clinical characteristics. Prevalence of CLD defined as presence of ≥2 respiratory symptoms or signs at enrolment was computed. Logistic regression analysis was performed to evaluate for association between various factors and presence or absence of CLD. Results We enrolled 320 CAHIV of median age 13 (IQR 10–16) years, 80 (25%) were <10 years, 46% were female, 31% lived in a one-room house and 51% used polluting cooking fuel. Antiretroviral therapy (ART) was initiated after age five years in 56%, 43% had prior pneumonia or tuberculosis, 11% had low CD4 count and 79% were virologically suppressed. Common respiratory symptoms and signs were exertional breathlessness (40%), chronic cough (23%), chest problems in the preceding year (24%), tachypnoea (52%), finger clubbing (6%), exercise limitation (59%) and oxygen desaturation during exercise (7%). CLD was present in 82 (26%) participants, and adding the six-minute walk distance <70% of predicted (exercise limitation) identified an additional 28 (9%) CAHIV with CLD. CLD was more common among older teenagers (odds ratio (OR) 1.95), those who had prior TB or pneumonia (OR 2.04), delayed initiation of ART (OR 2.60), cotrimoxazole prophylaxis (OR 3.35) or TB preventive therapy (OR 2.81). CLD was associated with viraemia (OR 2.7), lower quality of life (OR 12.7), small houses (OR 2.05), caregiver having fewer years of education (OR 2.46), outdoor pollution exposure (OR 3.31) and lower use of polluting cooking fuel indoors (OR 0.26). Adjusted analysis revealed CLD to be associated with prior tuberculosis or pneumonia (adjusted OR (aOR) [95%CI] 2.15 [1.18–3.91]), small house (aOR 1.95 [1.02–3.73]), lower use of polluting cooking fuel (aOR 0.35 [0.13–0.94]) and negative impact on health-related quality of life (aOR 6.91 [3.66–13.03]). Conclusions CLD is highly prevalent across the age spectrum of CAHIV, and most are symptomatic with cough or exertional breathlessness. CLD is associated with prior tuberculosis or pneumonia, socio-environmental factors, and lower quality of life. Structured interventions are needed to provide optimal care specific to their needs.

CITATION EXPORT

Elizabeth Maleche-Obimbo, Engi Attia, Fredrick Were et al.. Prevalence, clinical presentation and factors associated with chronic lung disease among children and adolescents living with HIV in Kenya. PLOS ONE. (2023). https://doi.org/10.1371/journal.pone.0289756

AUTHORS

8 · 7 CENTRES

Elizabeth Maleche-Obimbo, Engi Attia, Fredrick Were, Walter Jaoko, Stephen M Graham, Judith Kose, Judith Kose, Judith Kose

1Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
2Division of Paediatrics, Kenyatta National Hospital, Nairobi, Kenya
3Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, United States of America
4Department of Global Health, University of Washington, Seattle, Washington, United States of America
5Department of Medical Microbiology & Immunology, University of Nairobi, Nairobi, Kenya
6Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, Melbourne, Australia
7Africa Centre for Disease control, KENYA