Sovershaeva, EvgeniyaKranzer, KatharinaMchugh, GraceBandason, TsitsiMajonga, Edith D.Usmani, Omar S.Rowland-Jones, SarahGutteberg, ToreFlægstad, TrondFerrand, Rashida A.Odland, Jon Oyvind2020-07-082020-07-082019Sovershaeva, E., Kranzer, K., McHugh, G. et al. 2019, 'History of tuberculosis is associated with lower exhaled nitric oxide levels in HIV-infected children', AIDS, vol. 33, pp. 1711–1718.0269-9370 (print)1473-5571 (online)10.1097/QAD.0000000000002265http://hdl.handle.net/2263/75072OBJECTIVE : HIV disrupts host defense mechanisms and maintains chronic inflammation in the lung. Nitric oxide is a marker of lung inflammation and can be measured in the exhaled air. We investigated the relationship between exhaled nitric oxide (eNO), HIV status and airway abnormalities in perinatally HIV-infected children aged 6–19 years. DESIGN : A cross-sectional study. METHODS : HIV-infected individuals on antiretroviral therapy and HIV-uninfected children with no active tuberculosis (TB) or acute respiratory tract infection were recruited from a public hospital in Harare, Zimbabwe. Clinical history was collected and eNO testing and spirometry was performed. The association between eNO and explanatory variables (HIV, FEV1 z-score, CD4þ cell count, viral load, history of TB) was investigated using linear regression analysis adjusted for age, sex and time of eNO testing. RESULTS : In total, 222 HIV-infected and 97 HIV-uninfected participants were included. Among HIV-infected participants, 57 (25.7%) had a history of past TB; 56 (25.2%) had airway obstruction, but no prior TB. HIV status was associated with lower eNO level [mean ratio 0.79 (95% confidence interval, 95% CI 0.65–0.97), P¼0.03]. Within the HIV-infected group, history of past TB was associated with lower eNO levels after controlling for age, sex and time of eNO testing [0.79 (95% CI 0.67–0.94), P¼0.007]. CONCLUSION : HIV infection and history of TB were associated with lower eNO levels. eNO levels may be a marker of HIV and TB-induced alteration in pulmonary physiology; further studies focused on potential causes for lower eNO levels in HIV and TB are warranted.en© 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND).Airway obstructionHIV infectionSub-Saharan AfricaHuman immunodeficiency virus (HIV)Tuberculosis (TB)Exhaled nitric oxide (eNO)Article