Factors associated with reduced lung function in adolescents living with HIV in Nairobi, Kenya

Thesis (Master's)--University of Washington, 2020 ; Background: Over 5 million children and adolescents are living with HIV (ALWH) worldwide as a result of perinatally-acquired disease. Recent data support high prevalence of chronic respiratory symptoms in this population and a predominant phenotype of irreversible airflow obstruction. The objective of this study was to better understand factors associated with chronic lung disease in ALWH in Nairobi, Kenya. Methods: We conducted a cross-sectional study of adolescents aged 10-19 years with and without HIV in Nairobi, Kenya. We enrolled ALWH from a single HIV center and HIV-uninfected adolescents with similar sociodemographic characteristics. We administered standardized questionnaires and performed a focused respiratory exam and spirometry. Our primary outcome was post-bronchodilator FEV1 z-score (post zFEV1). We performed linear regression models evaluating the association between HIV infection and post zFEV1. We then restricted the analysis to ALWH and evaluated associations between a number of sociodemographic, clinical, and immune function factors and post zFEV1. Results: Among the 332 participants, 165 were ALWH (median age 15 years [IQR 13-18], 56% male) and 167 were HIV-uninfected (median age 14 years [IQR 12-17], 38% male). Compared to HIV-uninfected adolescents, ALWH of similar age, sex, smoke and biofuel exposure had 0.29 (95% CI -0.53, -0.05) lower post zFEV1 (p=0.019). Airflow obstruction was present in 10 (6%) ALWH and 10 (6%) HIV-uninfected adolescents (OR= 1.01 [95% CI 0.36, 2.79], p=1.0), while a restrictive pattern was present in 7% ALWH and 2% HIV-uninfected adolescents (OR= 3.90 [95% CI 1.00, 22.1], p=0.031). Among ALWH, factors associated with impaired post zFEV1 included lower BMI z-scores (p<0.001), clubbing (p=0.019), and abnormal lung sounds (p=0.006) in adjusted analysis. Markers of T cell imbalance were not associated with lung function in our analyses. Conclusion: HIV was an independent risk factor for reduced lung function. Airflow ...