Status: Funded - Open
Mechanisms and risk factors for abnormal chest CTs and spirometry among HIV+ adolescents in Nairobi
Engi Attia, M.D.
BACKGROUND: As increasing numbers of HIV+ children are surviving to adolescence in low- and middle-income countries, chronic lung disease is increasingly recognized among HIV+ adolescents.
GAP: Risk factors and mechanisms of chronic lung disease among HIV+ adolescents in low- and middle-income countries are not well characterized, and clinical interventions to prevent development and progression of chronic lung disease in this population are lacking.
HYPOTHESIS: We hypothesize that risk factors for chronic lung disease, defined by chest CT and spirometry abnormalities, among HIV+ adolescents include indoor biofuel burning, malnutrition, and ART initiation at low CD4 counts. Additionally, serum biomarkers of HIV severity, immune activation and inflammation are associated with chronic lung disease.
METHODS: This nested, cross-sectional study will recruit ~60 adolescents with vertically-acquired HIV who have no evidence of acute respiratory illness and are enrolled in care at an HIV clinic in Nairobi, Kenya. Participants will undergo non-contrast chest CT scans and blood draws for biomarkers. Spirometry, risk factor and clinical data will be abstracted from the parent study database; CD4 counts, ART use and other covariates were ascertained from the clinic’s records for the parent study. Multiple logistic and linear regression models will determine associations of risk factors and biomarkers with chest CT and spirometry results.
IMPACT: Results will provide critical data on risk factors and biomarkers associated with chronic lung disease that can potentially identify mechanistic pathways, earlier detection of disease, and targets for clinical interventions, including use of inhaled medications and potential anti-inflammatory therapy such as macrolides, to mitigate the chronic lung disease burden among HIV+ adolescents.
University of Washington
United States, Kenya