RESUMO
Lower respiratory tract diseases are major causes of morbidity and mortality in HIV infected children. We studied the lung disease features associated with AIDS in children and adolescents, in an era of ineffective antiretroviral therapy, between January 1996 and October 1998. This prospective, descriptive, longitudinal and historical medical chart review included 48 vertically HIV infected patients, receiving mono or double antiretroviral therapy, who had developed pulmonary disease. Those who presented acute pneumonia were classified into group 1; radiological changes for >or=3 months into group 2; those from group 1 and 2 who underwent lung biopsy into group 3. A rapidly progressive clinical course was found in 70.7% of the children and 37.5% younger than 6 months old. Bacterial pneumonia was diagnosed in all patients. High resolution chest computer tomographic scans (HRCT) from 27 patients showed a reticulonodular pattern in 8, ground-glass in 3, reticular in 3, nodular in 3, airspace consolidation in 3, mediastinal adenopathy in 3, pulmonary air cystic in 2 and air-trapping in 1. In five patients the HRCT were normal. Histopathology revealed: lymphoid interstitial pneumonitis in 5 patients, pulmonary lymphoid hyperplasia in 9, tuberculosis in 1, interstitial pneumonia in 1, diffuse alveolar damage in 1. Two patients had Cryptococcus neoformans and Mycobacterium tuberculosis. We conclude that lung diseases were the major risk factor for high morbidity, and an invasive diagnostic procedure may clarify the main cause for similar radiologic images of infectious and non-infectious processes.
Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Doenças Pulmonares Intersticiais/complicações , Pneumonia Bacteriana/complicações , Brasil/epidemiologia , Criança , Feminino , Humanos , Hiperplasia , Transmissão Vertical de Doenças Infecciosas , Estudos Longitudinais , Pulmão/patologia , Doenças Pulmonares Intersticiais/patologia , Tecido Linfoide/patologia , Masculino , Necrose , Pneumonia Bacteriana/patologia , Estudos Prospectivos , Fatores de Tempo , Tuberculose/patologiaRESUMO
HIV infection is associated with subnormal GSH levels. An increase in glutathione levels has been observed in HIV-infected adults under oral whey protein supplementation. We studied the features associated with a whey protein concentrate supplementation in children with rapidly progressive AIDS. A prospective double-blind clinical trial was carried out for 4 months with 18 vertically HIV-infected children (1.98-6.37 years), under antiretroviral therapy, who had received whey protein, maltodextrin (placebo) or none. Erythrocyte glutathione concentration, T lymphocyte counts (CD4+ and CD8+) and occurrence of associated co-infections were evaluated. Wilcoxon's and Fischer's Exact tests were used to assess differences between whey protein-supplemented and control (placebo and non-supplemented) groups. A significant median increase of 16.14 mg/dl (p = 0.018) in erythrocyte glutathione levels was observed in the whey protein-supplemented group; the TCD4/CD8 lymphocyte ratio showed a non significant increase and lower occurrence of associated co-infections was also observed. In conclusion, whey protein concentrate supplementation can stimulate glutathione synthesis and, possibly, decrease the occurrence of associated co-infections.