The role of tuberculosis coinfection on lung function of HIV infected children and adolescents in Africa. A systematic review

Abstract

Objectives: To systematically review existing literature on what role history of tuberculosis (TB) plays in lung function abnormalities and the development of chronic lung disease of HIV infected children and adolescents in Africa, as the burden of paediatric HIV and TB coinfection is the highest in this region. Methods: Systematic searches were performed in PubMed and EMBASE databases using PICO model. Other relevant studies were found through reading reviews and other articles. All included studies were evaluated for quality of evidence using GRADE. Results: Of 119 unique articles found through searches, 110 were excluded based on title and abstract, 3 additional studies were added, ending up with 12 studies in the review. 10 of the studies were cross-sectional, one was a prospective cohort and one was a randomized controlled trial. All studies reported spirometry as a measure of lung function. Four reported CT scans, three reported chest x-rays. HIV infected children and adolescents with a previous history of TB have a higher prevalence of reduced lung function measured by spirometry compared to HIV uninfected children and adolescents and HIV infected children and adolescents without prior TB. The main abnormality by spirometry reported was obstruction, and was associated with a previous history of TB. HIV infected children and adolescents also have higher prevalence of abnormalities on radiographical examinations, including findings suggestive of bronchiolitis and obliterative bronchiolitis (OB), irrespective of TB exposure. Conclusion: Recent research on issues of HIV-related comorbidities in children and adolescents has increased. However, most of the studies done to this date are of low or very low quality of evidence. Further studies of higher quality on HIV and TB coinfection and the long-term effects of disease and treatment are needed to better understand the pathogenesis, clinical recognition and to asses treatment options.