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OBJECTIVE: HIV disrupts host defense mechanisms and maintains chronic inflammation in the lung. Nitric oxide (NO) is a marker of lung inflammation and can be measured in the exhaled air. We investigated the relationship between exhaled NO (eNO), HIV status and airway abnormalities in perinatally HIV-infected children aged 6 to 19 years. DESIGN: 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, CD4 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% CI 0.65-0.97), p = 0.03). 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), p = 0.007). 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.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), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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