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Chronic Radiographic Lung Changes in Children with Vertically Transmitted HIV-1 Infection

¹ Department of Radiology, Mount Sinai School of Medicine, One Gustave Levy Pl., New York, NY 10029.
² Department of Pediatrics, Mount Sinai School of Medicine, New York, NY 10029.
³ Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195.
⁴ Present address: Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, 10900 Euclid Ave., Cleveland, OH 44106.
⁵ Department of Radiology, Children's Hospital, 300 Longwood Ave., Boston, MA 02115.
⁶ Department of Radiology, Texas Children's Hospital, 6621 Fannin St., Houston, TX 77030.
⁷ Department of Pediatrics, Columbia-Presbyterian Medical Center, 630 W.168 St., New York, NY 10032.
⁸ Department of Radiology, Columbia-Presbyterian Medical Center, New York, NY 10032.
⁹ Department of Radiology, University of California, 10833 Le Conte Ave., Los Angeles, CA 90095.
¹⁰ L.A.C./U.S.C., 1975 Zonal Ave., Los Angeles, CA 90033.
¹¹ Department of Radiology, Cleveland Clinic Foundation, Cleveland, OH 44195.
¹² Department of Pediatrics, Children's Hospital, 4650 Sunset Blvd., Los Angeles, CA 90027.

OBJECTIVE. We prospectively studied children with and without maternally transmitted HIV-1 infection born to mothers infected with HIV-1 to determine the incidence of chronic radiographic lung changes (CRC) and to correlate these changes with clinical assessments.

SUBJECTS AND METHODS. Between 1990 and 1997, we scored 3050 chest radiographs using a standardized form. Group I children (n = 201) were HIV-1—infected at enrollment. Group II children (n = 512) were enrolled prenatally or before 28 days postpartum and subsequently subdivided into group IIa (n = 86), children identified as HIV-1-infected; and group IIb (n = 426), those who were HIV-1—uninfected. CRC were defined as parenchymal consolidations or nodular disease lasting 3 months or more or increased bronchovascular markings or reticular densities lasting 6 months or more. Morbidity was assessed by CD4 counts, viral load, the presence of low oxygen saturation, wheezing, tachypnea, crackles, and clubbing.

RESULTS. The cumulative incidence of chronic radiographic lung changes in HIV-1—infected children was 32.8% by 4 years old, with increased bronchovascular markings or reticular densities being most common. Chronic changes were associated with lower CD4 cell counts and higher viral loads. Resolution of these chronic changes was associated with decreasing CD4 cell counts but not with lower rates of clinical findings, viral load, or difference in survival.

CONCLUSION. With increased survival, CRC are becoming more common. The resolution of these changes may indicate immunologic deterioration rather than clinical improvement.

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