Chronic radiographic lung changes in children with vertically transmitted HIV-I infection

OBJECTIVE. We prospectively studied children with and without maternally tr ansmitted HIV-1 infection born to mothers infected with HIV-1 to determine the incidence of chronic radiographic lung changes (CRC) and to correlate t hese changes with clinical assessments. SUBJECTS AND METHODS. Between 1990 and 1997, we scored 3050 chest radiograp hs using a standardized form. Group I children (n = 201) were HIV-1-infecte d at enrollment. Group II children (n = 512) were enrolled prenatally or be fore 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 n odular disease lasting 3 months or more or increased bronchovascular markin gs 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 H IV-1-infected children was 32.8% by 4 years old, with increased bronchovasc ular markings or reticular densities being most common. Chronic changes wer e 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 su rvival. CONCLUSION. With increased survival, CRC are becoming more common. The reso lution of these changes may indicate immunologic deterioration rather than clinical improvement.