Increased incidence of asthma in HIV-infected children treated with highly active antiretroviral therapy in the National Institutes of Health Women and Infants Transmission Study

Background

Immunoreconstitution of HIV⁺ patients after treatment with highly active antiretroviral therapy (HAART) appears to provoke inflammatory diseases.

Objective

We sought to determine whether HIV⁺ children receiving HAART (HIV⁺ HAART⁺) have a higher incidence of asthma than HIV⁺ children not receiving HAART (HIV⁺ HAART⁻).

Methods

Two thousand six hundred sixty-four children (193 HIV⁺ and 2471 HIV⁻ children) born to HIV⁺ women were evaluated for the incidence and prevalence of asthma (ie, asthma medication use) and change of CD4⁺ T-cell percentage with time.

Results

The HIV⁺ HAART⁺ children had higher CD4⁺ T-cell percentages, lower CD8⁺ T-cell percentages, and lower viral burdens than the HIV⁺ HAART⁻ children (P ≤ .05 to P ≤ .01). The cumulative incidence of asthma medication use in HIV⁺ HAART⁺ children at 13.5 years increased to 33.5% versus 11.5% in HIV⁺ HAART⁻ children (hazard ratio, 3.34; P = .01) and was equal to that in the HIV⁻ children. In children born before the HAART era, the prevalence of asthma medication use for HIV⁺ HAART⁺ children at 11 years of age was 10.4% versus 3.8% for HIV⁺ HAART⁻ children (odds ratio, 3.38; P = .02) and was equal to that of the HIV⁻ children. The rate of change of CD4⁺ T cells around the time of first asthma medication for HIV⁺ HAART⁺ versus HIV⁺ HAART⁻ children was 0.81%/y versus −1.43%/y (P = .01).

Conclusion

The increased incidence of asthma in HIV⁺ HAART⁺ children might be driven by immunoreconstitution of CD4⁺ T cells.

Key words: Pediatric HIV infection, CD4⁺ T cell–mediated induction of asthma, highly active antiretroviral therapy–produced immunoreconstitution

Abbreviations used: ART, Antiretroviral therapy, GEE, Generalized estimating equation, HAART, Highly active antiretroviral therapy, NNRTI, Nonnucleoside reverse transcriptase inhibitor, NRTI, Nucleoside reverse transcriptase inhibitor, PI, Protease inhibitor, WITS, Women and Infants Transmission Study