Multiple-Breath Washout Reveals Pulmonary Impairment in a Significant Subgroup of Youth with Perinatally Acquired HIV in Europe

Background : Chronic lung disease (CLD) is common in adults living with human immunodeficiency virus (HIV) and is associated with high morbidity and mortality despite the widespread availability of antiretroviral therapy (ART). Pulmonary impairment has also been reported in children, adolescents and young adults living with perinatally acquired HIV (CAPHIV). However, studies on pulmonary function (PF) in CAPHIV mainly stem from low-middle income countries (LMICs) and often exclusively report spirometric data. The aim of our study was to provide the first comprehensive evaluation of PF in a cohort of ART-treated CAPHIV in a high-income European setting. Methods: CAPHIV (n=51) living in Berlin underwent same-day PF assessment using spirometry, body plethysmography (BP), single-breath diffusion capacity of the lungs for carbon monoxide testing (DLCO) and multiple-breath washout (MBW). Results: All CAPHIV were on ART, median age was 15.1 (range 6.2–29.8) years, median age at ART initiation was 2.4 (range 0.0–13.4) years, viral load was undetectable in 90.2% of CAPHIV and median CD4 cell count was 730 (Interquartile range 590-960) cells/µl. Burden of respiratory symptoms was low. 46.3% of CAPHIV had a history of severe lower respiratory tract infection, history of pulmonal tuberculosis was rare (7.3%). Spirometry, BP and DLCO were preserved in most CAPHIV. Small airway dysfunction (SAD) reflected by a pathological lung clearance index (LCI) z-score in 27.9% of patients was the main finding. Conclusion: Our data is the first to demonstrate SAD in a well-treated cohort of CAPHIV living in a high-income setting in Europe. Pulmonary impairment is less severe than in previous data from LMICs and is most sensitively detected by MBW, which should therefore be considered for detection of early stages of pulmonary impairment irrespective of spirometry results. Multi-center studies using MBW are required and should include younger children living with HIV and CAPHIV with neurocognitive impairments. Publication History Article published online: 26 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany