History of tuberculosis is associated with lower exhaled nitric oxide levels in HIV-infected children

OBJECTIVE : HIV disrupts host defense mechanisms and maintains chronic inflammation in the lung. Nitric oxide is a marker of lung inflammation and can be measured in the exhaled air. We investigated the relationship between exhaled nitric oxide (eNO), HIV status and airway abnormalities in perinatally HIV-infected children aged 6–19 years. DESIGN : A cross-sectional study. METHODS : HIV-infected individuals on antiretroviral therapy and HIV-uninfected children with no active tuberculosis (TB) or acute respiratory tract infection were recruited from a public hospital in Harare, Zimbabwe. Clinical history was collected and eNO testing and spirometry was performed. The association between eNO and explanatory variables (HIV, FEV1 z-score, CD4þ cell count, viral load, history of TB) was investigated using linear regression analysis adjusted for age, sex and time of eNO testing. RESULTS : In total, 222 HIV-infected and 97 HIV-uninfected participants were included. Among HIV-infected participants, 57 (25.7%) had a history of past TB; 56 (25.2%) had airway obstruction, but no prior TB. HIV status was associated with lower eNO level [mean ratio 0.79 (95% confidence interval, 95% CI 0.65–0.97), P¼0.03]. Within the HIV-infected group, history of past TB was associated with lower eNO levels after controlling for age, sex and time of eNO testing [0.79 (95% CI 0.67–0.94), P¼0.007]. CONCLUSION : HIV infection and history of TB were associated with lower eNO levels. eNO levels may be a marker of HIV and TB-induced alteration in pulmonary physiology; further studies focused on potential causes for lower eNO levels in HIV and TB are warranted.The Global Health and Vaccination Research (GLOBVAC) Programme of the Medical Research Council of Norway and by HelseNord (HNF 1387-17). R.A.F. is funded by the Wellcome Trust (206316/Z/17/Z).http://journals.lww.com/aidsonlineam2020School of Health Systems and Public Health (SHSPH