Lack of Efficacy of an Immunomodulatory Macrolide in Childhood HIV Related Bronchiectasis: A Randomised, Placebo-Controlled Trial
- *Corresponding Author:
- Refiloe Masekela
Department of Paediatrics and Child Health
Level 3 Bridge C, Steve Biko Academic Hospital
Malherbe Street, Capital Park, Pretoria, 0001, South Africa
E-mail: [email protected]
Received Date: February 06, 2013; Accepted Date: March 28, 2013; Published Date: March 30, 2013
Citation: Masekela R, Anderson R, Gongxeka H, Steel HC, Becker PJ, et al. (2013) Lack of Efficacy of an Immunomodulatory Macrolide in Childhood HIV-Related Bronchiectasis: A Randomised, Placebo-Controlled Trial. J Antivir Antiretrovir 5:044-049. doi: 10.4172/jaa.1000062
Copyright: © 2013 Masekela R, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: The epidemic of human immunodeficiency virus (HIV)-1 infection has resulted in a large number of children suffering from respiratory morbidity in South Africa. One of the outcomes of recurrent chest infections and TB is HIV-related bronchiectasis.
Introduction: We conducted a randomised, double-blind, placebo-controlled trial to assess the efficacy of low dose erythromycin in reducing the number of pulmonary exacerbations.
Methods: We randomly assigned 31 HIV-infected children with radiologically confirmed bronchiectasis, to receive either erythromycin (17) or matching placebo (14) for a period of 52 weeks. The primary outcome was the number of exacerbations documented over the 52 weeks, in each study arm, after randomisation. Results: There was no difference in the number of exacerbations in the participants receiving erythromycin versus those receiving placebo (2.14 ± 1.29 vs. 2.18 ± 1.59 per year; p=0.17). There was an improvement (although not statistically significant) in both FEV1 % predicted and FVC % predicted (56.0% predicted ± 15.1 to 68.0% predicted ± 21.0 and 53.5% predicted ± 13.6 to 62.5% predicted ± 13.6; p=0.31) in the erythromycin and placebo arm, respectively. Erythromycin did not impact the levels of pro-inflammatory and anti-inflammatory cytokines (all p>0.05).
Conclusion: Administration of HAART and adjunctive care, which includes airway clearance and treatment of exacerbations, in children with HIV-related bronchiectasis is associated with improvement in pulmonary function tests and IL-8, with no additional benefit from the use of erythromycin.