Lack of efficacy of an immunomodulatory macrolide in childhood HIV related bronchiectasis: A randomised, placebo-controlled trial

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. © 2013 Masekela R, et al.