The effect of azithromycin for management of HIV-associated chronic lung disease on right heart function: Results from the BREATHE trial

Background: Right heart abnormalities and pulmonary hypertension (PH) may be secondary to chronic lung disease. Chronic lung disease is common in children with HIV. In the BREATHE trial (Trial registration: NCT02426112), azithromycin (AZM) reduced the risk of acute respiratory exacerbations in child...

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Autores principales:	Edith D. Majonga, Gugulethu Newton Mapurisa, Andrea M. Rehman, Grace McHugh, Tsitsi Bandason, Hilda Mujuru, Carmen Gonzalez-Martinez, Jon O. Odland, Neil Kennedy, Rashida A. Ferrand
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Children Adolescents Africa HIV Chronic lung disease Right heart Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/b795618d2b244eca8e24f8b61cf344f4
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spelling	oai:doaj.org-article:b795618d2b244eca8e24f8b61cf344f42021-11-22T04:27:21ZThe effect of azithromycin for management of HIV-associated chronic lung disease on right heart function: Results from the BREATHE trial2352-906710.1016/j.ijcha.2021.100920https://doaj.org/article/b795618d2b244eca8e24f8b61cf344f42021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2352906721002086https://doaj.org/toc/2352-9067Background: Right heart abnormalities and pulmonary hypertension (PH) may be secondary to chronic lung disease. Chronic lung disease is common in children with HIV. In the BREATHE trial (Trial registration: NCT02426112), azithromycin (AZM) reduced the risk of acute respiratory exacerbations in children aged 6–19 years with HIV-associated chronic lung disease (HCLD) taking antiretroviral therapy. We assessed the possible effect of AZM on right heart dysfunction and/or PH in the trial. Methods: A standardised transthoracic echocardiogram using M-mode, two-dimensional and Doppler was performed, at baseline and at completion of weight-based AZM given weekly for 48 weeks. Linear regression was used to compare trial arms. Results: A total of 169 participants (82 AZM arm; 87 placebo arm) were included. Participants in the placebo arm were older, median age 16.2 (13.0–18.2) vs 15.3 (12.9–17.4) years, p = 0.184 in the AZM arm. At baseline, right heart abnormalities (right ventricular systolic dysfunction (RVSD), dilatation, or PH) were observed in 7(4%). Following treatment, there was no difference in prevalence of RVSD between arms (p = 0.761). There was one incident case of suspected PH, and overall, no difference in pulmonary pressures. Conclusion: In children with HCLD, there was evidence of secondary cardiac effects, but AZM had no effect on right heart function. Long-term follow-up in children with HIV should be part of future research to understand the clinical implications of right heart abnormalities.Edith D. MajongaGugulethu Newton MapurisaAndrea M. RehmanGrace McHughTsitsi BandasonHilda MujuruCarmen Gonzalez-MartinezJon O. OdlandNeil KennedyRashida A. FerrandElsevierarticleChildrenAdolescentsAfricaHIVChronic lung diseaseRight heartDiseases of the circulatory (Cardiovascular) systemRC666-701ENInternational Journal of Cardiology: Heart & Vasculature, Vol 37, Iss , Pp 100920- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Children Adolescents Africa HIV Chronic lung disease Right heart Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Children Adolescents Africa HIV Chronic lung disease Right heart Diseases of the circulatory (Cardiovascular) system RC666-701 Edith D. Majonga Gugulethu Newton Mapurisa Andrea M. Rehman Grace McHugh Tsitsi Bandason Hilda Mujuru Carmen Gonzalez-Martinez Jon O. Odland Neil Kennedy Rashida A. Ferrand The effect of azithromycin for management of HIV-associated chronic lung disease on right heart function: Results from the BREATHE trial
description	Background: Right heart abnormalities and pulmonary hypertension (PH) may be secondary to chronic lung disease. Chronic lung disease is common in children with HIV. In the BREATHE trial (Trial registration: NCT02426112), azithromycin (AZM) reduced the risk of acute respiratory exacerbations in children aged 6–19 years with HIV-associated chronic lung disease (HCLD) taking antiretroviral therapy. We assessed the possible effect of AZM on right heart dysfunction and/or PH in the trial. Methods: A standardised transthoracic echocardiogram using M-mode, two-dimensional and Doppler was performed, at baseline and at completion of weight-based AZM given weekly for 48 weeks. Linear regression was used to compare trial arms. Results: A total of 169 participants (82 AZM arm; 87 placebo arm) were included. Participants in the placebo arm were older, median age 16.2 (13.0–18.2) vs 15.3 (12.9–17.4) years, p = 0.184 in the AZM arm. At baseline, right heart abnormalities (right ventricular systolic dysfunction (RVSD), dilatation, or PH) were observed in 7(4%). Following treatment, there was no difference in prevalence of RVSD between arms (p = 0.761). There was one incident case of suspected PH, and overall, no difference in pulmonary pressures. Conclusion: In children with HCLD, there was evidence of secondary cardiac effects, but AZM had no effect on right heart function. Long-term follow-up in children with HIV should be part of future research to understand the clinical implications of right heart abnormalities.
format	article
author	Edith D. Majonga Gugulethu Newton Mapurisa Andrea M. Rehman Grace McHugh Tsitsi Bandason Hilda Mujuru Carmen Gonzalez-Martinez Jon O. Odland Neil Kennedy Rashida A. Ferrand
author_facet	Edith D. Majonga Gugulethu Newton Mapurisa Andrea M. Rehman Grace McHugh Tsitsi Bandason Hilda Mujuru Carmen Gonzalez-Martinez Jon O. Odland Neil Kennedy Rashida A. Ferrand
author_sort	Edith D. Majonga
title	The effect of azithromycin for management of HIV-associated chronic lung disease on right heart function: Results from the BREATHE trial
title_short	The effect of azithromycin for management of HIV-associated chronic lung disease on right heart function: Results from the BREATHE trial
title_full	The effect of azithromycin for management of HIV-associated chronic lung disease on right heart function: Results from the BREATHE trial
title_fullStr	The effect of azithromycin for management of HIV-associated chronic lung disease on right heart function: Results from the BREATHE trial
title_full_unstemmed	The effect of azithromycin for management of HIV-associated chronic lung disease on right heart function: Results from the BREATHE trial
title_sort	effect of azithromycin for management of hiv-associated chronic lung disease on right heart function: results from the breathe trial
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/b795618d2b244eca8e24f8b61cf344f4
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The effect of azithromycin for management of HIV-associated chronic lung disease on right heart function: Results from the BREATHE trial

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