Surgery for bronchiectasis in children living with HIV: A case series from a low- to middle-income country.

Abstract

Background: Bronchiectasis (BE) in children living with HIV (CLWH) remains a significant cause of morbidity and mortality, especially in tuberculosis (TB)-endemic low- and middle-income countries. Treatment modalities for BE in CLWH currently focus mainly on prevention of infections and management of symptoms, while surgical management is indicated for a select group. In contrast, surgical management in non-cystic fibrosis BE is well established.

Objectives: To describe the indications for and complications of surgical resection for BE in CLWH, and to identify variables influencing outcome.

Methods: A retrospective medical records review was conducted of all CLWH aged ≤14 years who underwent surgical resection for BE at Tygerberg Hospital, Cape Town, South Africa, between 1 January 2007 and 30 September 2014. The variables collected included immune status, antiretroviral treatment (ART), previous treatment for TB, operative and postoperative complications, and postoperative symptom relief.

Results: Twelve CLWH on ART with symptomatic BE underwent surgical resection. The mean age was 7 years and the mean CD4 count 970 cells/µL. Indications for surgery included recurrent infections, chronic cough and persistent lobar collapse. The most common procedures were left lower lobe lobectomy (42%), left pneumonectomy (17%) and right bilobectomy (17%). Complications were limited to persistent pneumothorax after surgery in one child. There were no deaths. Ten children (83%) showed significant improvement of symptoms at follow-up.

Conclusion: Surgical resection for BE in CLWH can be performed safely with a low complication rate, resulting in significant improvement of symptoms postoperatively.

Study synopsis: What the study adds. Bronchiectasis (BE) in children living with HIV (CLWH) is a significant cause of morbidity and mortality. Current treatment focuses on preventing infections and managing symptoms, while surgical management is rarely considered. A retrospective medical records review of 12 children aged ≤14 years in South Africa found that surgical resection for BE can be performed with a low complication rate, resulting in significant improvement of symptoms postoperatively. Variables influencing outcome include immune status, antiretroviral treatment and previous treatment for tuberculosis.Implications of the findings. This study demonstrates that surgery for BE can be performed safely in CLWH, with significant improvement of respiratory symptoms postoperatively.