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

Karen I. Norton1,2, Meyer Kattan2, J. Sunil Rao3,4, Robert Cleveland5, Lynn Trautwein6, Robert B. Mellins7, Walter Berdon8, M. Ines Boechat9, Beverly Wood10, Moulay Meziane11, Arnold C. G. Platzker12 and the P2C2 HIV Study Group

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.



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  		Fig. 1. —Normal frontal chest radiograph of 2-year-old boy from group I, as assessed by standardized forced-choice grading system.

 


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  		Fig. 2. —Frontal chest radiograph of 6-year-old girl from group I shows persistent bibasilar infiltrates, left greater than right.

 


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  		Fig. 3. —Radiograph of 20-month-old group I boy shows persistent increased bronchovascular or reticular densities. Lungs are hyperinflated. Scattered tubular densities are present, consistent with subsegmental atelectasis and mucous plugging.

 


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  		Fig. 4A. —Group I girl with persistent nodular densities. Frontal radiograph at age 3 reveals multiple small nodules throughout both lungs.

 


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  		Fig. 4B. —Group I girl with persistent nodular densities. Frontal radiograph at age 5 shows that nodular densities have resolved.

 


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  		Fig. 5. —Graph shows model-based means and 95% confidence intervals for CD4 count (cells/mm3) from time since first test in HIV-1-infected children with and without chronic radiographic lung changes (CRC) and HIV-1-uninfected children. Note that HIV-1-infected children with CRC had lowest CD4 count. HIV-1-infected without CRC is significantly different from HIV-1-uninfected without CRC (p < 0.001). HIV-1-infected with CRC is significantly different from HIV-1-uninfected without CRC (p < 0.001). HIV-1-infected with CRC is significantly different from HIV-1-infected without CRC (p < 0.001). Top line = HIV-1-uninfected children without CRC, middle line = HIV-1-infected children without CRC, bottom line = HIV-1-infected children with CRC.

 


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  		Fig. 6. —Graph shows Kaplan-Meier survival curve estimates of HIV-1-infected children with and without chronic radiographic lung changes (CRC) for groups I and IIa combined. There was no significant difference in survival between children with any CRC or without CRC (p = 0.71 by log-rank test). Curves were similar when groups I and IIa were analyzed separately (not shown). CRC is defined as any chronic radiographic lung change (parenchymal consolidations >=3 months, bronchovascular markings or reticular densities >=6 months, or nodular densities >=3 months). Solid line = HIV-1-infected children with CRC (n = 83), broken line = HIV-1-infected children without CRC (n = 204).

 

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