Highly active antiretroviral therapy might increase risk of asthma in young children

Aug 29 2008

Highly active antiretroviral therapy might increase the risk of asthma among children because of the therapy's effect on the immune system and CD4+ T cell levels, according to a study recently published in the Journal of Allergy and Clinical Immunology, Reuters reports.

According to Reuters, in asthma, an excess of inflammatory and immune cells are produced in the lungs. Therefore, any condition or therapy that bolsters these cells, including HAART, could have an "unwanted effect," Reuters reports.

For the study, William Shearer of Texas Children's Hospital and colleagues examined the incidence and prevalence of asthma in children born to HIV-positive women. The study included 193 children living with HIV, 113 of whom were treated with HAART and 80 of whom never had received HAART. The study also included 2,471 children who were HIV-negative. The researchers found 33.5% asthma medication use among the HAART-treated children of an average age of 13.5, compared with 11.5% among the HIV-positive children who were not treated with HAART. Asthma medication use among HAART-treated children was slightly higher than among HIV-negative children, suggesting that untreated HIV might protect against asthma, according to Reuters. Additional analysis found that it was an increase in T cell levels from HAART that increased the risk of asthma, Reuters reports.

Shearer said that because studies performed before HAART's introduction in the mid-1990s did not detect the problem, "investigators have assumed that asthma is not a complication of pediatric HIV infection." Before HAART was available, T cells levels often decreased among HIV-positive people, preventing an asthmatic reaction. "It was not until the era of HAART, which restored the (T cell) levels, that an increased incidence of asthma was noted," Shearer said. He added that until further research is conducted to verify the findings, physicians should be aware that HAART could increase the risk of asthma among children. In addition, physicians need to alert parents to the issue and provide children with asthma treatment if it occurs, Shearer said (Gale, Reuters, 8/26).