Airway Resistance and Spirometry in Children With Perinatally Acquired Human Immunodeficiency Virus-Type 1 Infection M. de Martino, MD, 1 * G. Veneruso, MD, 2 C. Gabiano, MD, 3 G. Frongia, MD, 2 S. Tulisso, MD, 3 E. Lombardi, MD, 2 P.-A. Tovo, MD, 4 L. Galli, MD, 2 and A. Vierucci, MD 2 Summary. Airway resistance was measured by the interrupter technique in 54 children [aged 63.8 months (range: 9.1–131.6 months)], with perinatal human immunodeficiency virus-type 1 (HIV-1) infection and in a control group of 315 gender, height, and race-matched healthy chil- dren. In addition, 14 HIV-infected children, aged 75–131 months, had spirometry performed. Resistance was significantly higher in infected children than in controls (0.84 ± 0.3 vs 0.64 ± 0.08 kPa  l -1  s; t = 9.991; P < 0.0001). Resistance decreased with age in controls (r = -0.95; P < 0.001), but not in infected children (r = -0.22; P = 0.105). Resistance did not correlate with mothers’ intravenous drug addiction, perinatal data, T-cell subset numbers, treatment, clinical course, or presence of respiratory complications. Resistance was higher (t = 3.103; P < 0.003) in p24 antigen-positive than in negative children. Thirty-nine children underwent a second evalu- ation 12.3 months (range 11.1–14 months) after the first. Resistance was higher (t = 3.960; P < 0.0001) at the second evaluation compared to the first. Eight of 14 children had abnormal spirometric measurements. We conclude that perinatal HIV-1 infection is associated with in- creased airway resistance and often abnormal spirometry. The degree of abnormalities in re- sistance depends on the duration of the infection rather than on HIV-1-related respiratory com- plications. Pediatr. Pulmonol. 1997; 24:406–414. © 1997 Wiley-Liss, Inc. Key words: human immunodeficiency virus infection; infants; lung function; chronic lung disease; spirometry. INTRODUCTION Pulmonary function has been widely investigated in adults with HIV-1 infection. Information is available on total lung capacity, alveolar–arterial oxygen gradients, carbon monoxide diffusing capacity, oxygen saturation after exercise challenge, peak expiratory flow, FVC, FEV1 at baseline and after challenge, and the FEV1/FVC ratio. 1–6 Changes observed may have a dual etiology, namely, primary HIV-1 infection and HIV-1-related complications. 7,8 Studies agree in regard to changes in pulmonary function during severe respiratory complica- tions, particularly opportunistic infections such as PCP. The role of HIV-1 infection by itself in directly changing pulmonary function is suggested by some 1,3–5 but denied by other 2,6 investigators. Most studies on changes in pul- monary function are based on the duration of HIV-1- related diseases rather than primary HIV-1 infection 2 and may be biased by intravenous drug addiction and smok- ing habits. 3,7 In children with perinatally acquired HIV-1 infection, age and duration of infection coincide 9 and confounding factors are absent. No parameters of pulmo- nary function have been investigated extensively in this age group. The present study reports data on airway re- sistance and in a subgroup of older children on spiromet- ric measurements in perinatally HIV-infected children. MATERIALS AND METHODS Case Definition Perinatal HIV-1 infection was defined as previously reported. 10 Infection was diagnosed through detection of 1 Department of Medicine, Division of Pediatrics, University of Chieti, Chieti, Italy. 2 Department of Pediatrics, University of Florence, Florence, Italy. 3 Department of Pediatrics, University of Turin, Turin, Italy. 4 Institute of Pediatrics, University of Novara, Novara, Italy. Contract grant sponsor: Italian Minstero della Sanita `—Istituto Supe- riore di Sanita `; Contract grant number 9405.18. *Correspondence to: Prof. Maurizio de Martino, Department of Medi- cine, Division of Pediatrics, University of Chieti, Colle dell’ Ara, via dei Vestini, I-66100 Chieti, Italy. Received 26 April 1996; accepted 2 July 1997. Pediatric Pulmonology 24:406–414 (1997) © 1997 Wiley-Liss, Inc.