Azithromycin does not improve lung function in HIV-associated chronic lung disease in children: JAMA

UK: Prophylactic use of azithromycin was associated with a lower rate of acute respiratory exacerbations (AREs) in children with HIV-associated chronic lung disease (HCLD) but did not improve lung function, suggests a recent study. Further the study, published in JAMA Network Open, found hospitalizations to be lower in azithromycin groip but the difference was not significant.

Despite the use of antiretroviral therapy (ART), HCLD is common in children (and is associated with small airways disease) and can lead to substantial. morbidity. Azithromycin has immunomodulatory and antibiotic activity and may be effective for the treatment of HCLD through the reduction of respiratory tract infections and inflammation. Considering this, Rashida A. Ferrand, London School of Hygiene and Tropical Medicine, London, United Kingdom, and colleague aimed to determine whether prophylactic azithromycin is effective in preventing worsening of lung function and in reducing AREs in children with HCLD taking ART in the BREATHE trial.

BREATHE is a double-blind, placebo-controlled, randomized clinical trial conducted between 2016 and 2019, including 12 months of follow-up, at outpatient HIV clinics in 2 public sector hospitals in Malawi and Zimbabwe. 347 patients were randomized in the ratio of 1:1 to receive either once-weekly oral azithromycin with weight-based dosing, for 48 weeks (azithromycin group; n=174) or placebo (placebo group; n=173); ; 162 participants in the azithromycin group and 146 placebo group participants had a primary outcome available and were analyzed.