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Impact of HIV and antiretroviral drug exposure on lung growth and function over 2 years in an African birth cohort

Gray, D.M
Wedderburn, C.J
MacGinty, R.P
McMillan, L
Jacobs, C
Stadler, J.A
Hall, G.L
Zar, H.J
Objective: To assess the impact of HIV and antiretroviral exposure without infection on lung growth and function over the first 2 years of life. Design: Prospective observational study of an African birth cohort, Drakenstein Child Health Study. Method: Infants enrolled antenatally had lung function measured at 6 weeks, 1 and 2 years. HIV-infected women received antiretroviral therapy (ART) as per local guidelines. The association between HIV and antiretroviral exposure with lung function was assessed using mixed effects modelling. Results: Of 1143 infants born, two HIV-infected infants were excluded from analysis; 909 (80%) infants had lung function collected at 6 weeks [190 (21%) were HIV-exposed uninfected (HEU)]; 782 (69%) at 1 year and 741 (65%) at 2 years. At 6 weeks HEU infants had larger tidal volume compared with HIV-unexposed infants (1.13 ml, confidence interval: 0.02–2.23, P = 0.045). High maternal viral load was associated with a 17% lower expiratory flow over 2 years (0.17, confidence interval 0.00–0.34, P = 0.046). First-line ART initiated during pregnancy was associated with lower infant tidal volume at 6 weeks compared with those who initiated ART before pregnancy (−2.7 ml, −5.31 to −0.10, P = 0.042), and low maternal CD4+ cell counts associated with lower infant tidal over 2 years (−11.1 ml, −18.58–3.58, P = 0.004). Conclusion: HIV exposure is associated with altered lung function in early life, with a vulnerable HEU subgroup based on maternal disease severity, immunological compromise and ART exposure. These data highlight the importance of ongoing surveillance of respiratory health in HEU children.
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Wolters Kluwer
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HIV exposure,HIV,Lung function,Infant,Antiretroviral therapy
Gray DM, Wedderburn CJ, MacGinty RP, McMillan L, Jacobs C, Stadler JAM, Hall GL, Zar HJ. Impact of HIV and antiretroviral drug exposure on lung growth and function over 2 years in an African Birth Cohort. AIDS. 2020 Mar 15;34(4):549-558. doi: 10.1097/QAD.0000000000002444.
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