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

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 obstruction and restrictive patterns were present in a minority of our study population. Clinically available factors are associated with reduced lung function and may be useful for identifying individuals with reduced lung function in settings where diagnostic testing is not readily available.