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Acute respiratory exacerbations (ARE) are common among this group and cause significant morbidity. Exhaled nitric oxide (eNO) is a known marker of local airway inflammation. We investigated the association between eNO and ARE, biomarkers of systemic inflammation, and the effect of azithromycin on eNO levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Individuals aged 6\u201319\u2009years with HIV\u2010associated chronic lung disease in Harare, Zimbabwe, were enrolled in a placebo\u2010controlled randomized trial investigating the effect of 48\u2010week azithromycin treatment on lung function and ARE. eNO levels and biomarkers were measured at inclusion and after treatment in a consecutively enrolled subset of participants. Linear regression and generalized linear models were used to study associations between eNO and ARE, biomarkers, and the effect of azithromycin on eNO levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 172 participants were included in this sub\u2010study, 86 from the placebo group and 86 from the azithromycin group. Participants experiencing at least one ARE during follow\u2010up had significantly higher eNO levels at baseline than participants who did not (geometric mean ratio 1.13, 95% confidence interval [CI] 1.03\u20131.24, <jats:italic>p<\/jats:italic>\u2009=\u20090.015), adjusted for trial arm, age, sex and history of tuberculosis. Matrix metalloproteinase (MMP)\u20103, \u20107, and \u201010 were significantly associated with higher baseline eNO levels. At 48\u2009weeks, azithromycin treatment did not affect eNO levels (geometric mean ratio 0.86, 95% CI 0.72\u20131.03, <jats:italic>p<\/jats:italic>\u2009=\u20090.103).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Higher baseline eNO levels were a risk factor for ARE. eNO was associated with proinflammatory biomarkers previously found to contribute to the development of chronic lung disease. The potential use of eNO as a marker of inflammation and risk factor for ARE in HIV\u2010associated chronic lung disease needs further investigation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.13565","type":"journal-article","created":{"date-parts":[[2023,10,8]],"date-time":"2023-10-08T18:39:36Z","timestamp":1696790376000},"page":"223-232","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Exhaled nitric oxide is associated with inflammatory biomarkers and risk of acute respiratory exacerbations in children with <scp>HIV<\/scp>\u2010associated chronic lung disease"],"prefix":"10.1111","volume":"25","author":[{"given":"Trym Thune","family":"Flygel","sequence":"first","affiliation":[{"name":"Paediatric Research Group, Department of Clinical Medicine, Faculty of Health sciences UiT \u2013 The Arctic University of Norway  Troms\u00f8 Norway"},{"name":"Department of Paediatrics University Hospital of North Norway  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