BRONCHIECTASIS IN PEDIATRIC AIDS

Objectives: There are several reports of the pulmonary findings in chi ldren with HIV disease; however, the occurrence of bronchiectasis rare ly has been noted. We evaluated occurrence of bronchiectasis in a larg e group of children referred to us with AIDS pneumopathy. Methods: Fro m January 1984 to April 1996, 203 children with AIDS and respiratory p roblems were referred to the pediatric pulmonary division at Children' s Medical Center of Brooklyn. Medical records for 164 of these childre n were available and retrospectively reviewed. Results: Uncomplicated pneumonia was present in 75, 24 had recurrent pneumonia, and 18 had un resolved pneumonia; lymphocytic interstitial pneumonitis (LIP) was dia gnosed in 47 patients, worsening with time in all patients. Bronchiect asis was observed in 26 patients (26/164, 15.8%), diagnosed by chest r adiograph in 26 (26/26, 100%), confirmed by CT scan of chest in 10 (10 /26, 38.4%), and by histology in three (3/26, 11.5%). Median age at ti me of diagnosis of bronchiectasis was 7.5 years (range, 1 to 16 years) . Sixteen children with LIP developed bronchiectasis (16/47, 34.0%). T hree patients with recurrent pneumonia (3/24, 12.5%) developed bronchi ectasis. Five patients with unresolved pneumonia (5/18, 27.7%) develop ed bronchiectasis. One infant developed bronchiectasis after Pneumocys tis carinii pneumonia; another child developed bronchiectasis after P carinii and Mycobacterium tuberculosis pneumonia. The CD4+ T-cell coun ts measured within 6 months of diagnosis of bronchiectasis were availa ble in 23/26 patients and, all were <100 cells per cubic millimeter. C onclusion: We conclude, from our experience, that there is a significa nt occurrence of bronchiectasis in children with AIDS and pulmonary di sease, especially in children developing LIP, recurrent pneumonia and unresolved pneumonia, and CD4+ T-cell counts <100 cells per cubic mill imeter.