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Díez-Manglano J, Del Corral-Beamonte E. Pulmonary Function in People Living With Human Immunodeficiency Virus: A Meta-Analysis. Arch Bronconeumol 2024; 60:200-206. [PMID: 38311508 DOI: 10.1016/j.arbres.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND HIV can infect bronchial epithelial cells rendering individuals susceptible to lung damage. Our objective was to determine the effects of human immunodeficiency virus (HIV) infection on pulmonary function tests. METHODS We performed a meta-analysis after conducting a literature search in PubMed, Embase, Cochrane Library and Virtual Health Library databases from inception to December 31st, 2022. We employed the inverse variance method with a random effects model to calculate the effect estimate as the mean difference (MD) and 95% confidence interval (CI). We calculated the heterogeneity with the I2 statistic and performed a meta-regression analysis by age, sex, smoking, CD4 T-cells count and antiretroviral therapy. We also conducted a sensitivity analysis according to the studies' publication date, and excluding the study with the greatest weight in the effect. The PROSPERO registry number was CRD42023401105. RESULTS The meta-analysis included 20 studies, with 7621 living with HIV and 7410 control participants. The pooled MD (95%CI) for the predicted percentage of FEV1, FVC and DLCO were -3.12 (-5.17, -1.06); p=0.003, -1.51 (-3.04, 0.02); p=0.05, and -5.26 (-6.64, -3.87); p<0.001, respectively. The pooled MD for FEV1/FVC was -0.01 (-0.02, -0.01); p=0.002. In all cases, there was a considerable heterogeneity. The meta-regression analysis showed that among studies heterogeneity was not explained by patient age, smoking, CD4 T-cells count or antiretroviral therapy. CONCLUSION Pulmonary function tests are impaired in people living with HIV, independently of age, smoking, CD4 T-cells count, and geographical region.
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Affiliation(s)
- Jesús Díez-Manglano
- Department of Internal Medicine, University Hospital Royo Villanova, Zaragoza, Spain; Department of Medicine, University of Zaragoza, Spain.
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Konstantinidis I, Crothers K, Kunisaki KM, Drummond MB, Benfield T, Zar HJ, Huang L, Morris A. HIV-associated lung disease. Nat Rev Dis Primers 2023; 9:39. [PMID: 37500684 PMCID: PMC11146142 DOI: 10.1038/s41572-023-00450-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/29/2023]
Abstract
Lung disease encompasses acute, infectious processes and chronic, non-infectious processes such as chronic obstructive pulmonary disease, asthma and lung cancer. People living with HIV are at increased risk of both acute and chronic lung diseases. Although the use of effective antiretroviral therapy has diminished the burden of infectious lung disease, people living with HIV experience growing morbidity and mortality from chronic lung diseases. A key risk factor for HIV-associated lung disease is cigarette smoking, which is more prevalent in people living with HIV than in uninfected people. Other risk factors include older age, history of bacterial pneumonia, Pneumocystis pneumonia, pulmonary tuberculosis and immunosuppression. Mechanistic investigations support roles for aberrant innate and adaptive immunity, local and systemic inflammation, oxidative stress, altered lung and gut microbiota, and environmental exposures such as biomass fuel burning in the development of HIV-associated lung disease. Assessment, prevention and treatment strategies are largely extrapolated from data from HIV-uninfected people. Smoking cessation is essential. Data on the long-term consequences of HIV-associated lung disease are limited. Efforts to continue quantifying the effects of HIV infection on the lung, especially in low-income and middle-income countries, are essential to advance our knowledge and optimize respiratory care in people living with HIV.
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Affiliation(s)
- Ioannis Konstantinidis
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kristina Crothers
- Veterans Affairs Puget Sound Healthcare System and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ken M Kunisaki
- Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - M Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Heather J Zar
- Department of Paediatrics & Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Laurence Huang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Alison Morris
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Byanova KL, Fitzpatrick J, Jan AK, McGing M, Hartman-Filson M, Farr CK, Zhang M, Gardner K, Branchini J, Kerruish R, Bhide S, Bates A, Hsieh J, Abelman R, Hunt PW, Wang RJ, Crothers KA, Huang L. Isolated abnormal diffusing capacity for carbon monoxide (iso↓DLco) is associated with increased respiratory symptom burden in people with HIV infection. PLoS One 2023; 18:e0288803. [PMID: 37463173 PMCID: PMC10353811 DOI: 10.1371/journal.pone.0288803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES An isolated reduction in the diffusing capacity for carbon monoxide (DLco; iso↓DLco) is one of the most common pulmonary function test (PFT) abnormalities in people living with HIV (PWH), but its clinical implications are incompletely understood. In this study, we explored whether iso↓DLco in PWH is associated with a greater respiratory symptom burden. STUDY DESIGN Cross-sectional analysis. METHODS We used ATS/ERS compliant PFTs from PWH with normal spirometry (post-bronchodilator FEV1/FVC ≥0.7; FEV1, FVC ≥80% predicted) from the I AM OLD cohort in San Francisco, CA and Seattle, WA, grouped by DLco categorized as normal (DLco ≥lower limit of normal, LLN), mild iso↓DLco (LLN >DLco >60% predicted), and moderate-severe iso↓DLco (DLco ≤60% predicted). We performed multivariable analyses to test for associations between DLco and validated symptom-severity and quality of life questionnaires, including the modified Medical Research Council dyspnea scale (mMRC), the COPD Assessment Test (CAT), and St. George's Respiratory Questionnaire (SGRQ), as well as between DLco and individual CAT symptoms. RESULTS Mild iso↓DLco was associated only with a significantly higher SGRQ score. Moderate-severe iso↓DLco was associated with significantly higher odds of mMRC ≥2 and significantly higher CAT and SGRQ scores. PWH with moderate-severe iso↓DLco had increased odds of breathlessness, decreased activity, lower confidence leaving home, and less energy. CONCLUSIONS Iso↓DLco is associated with worse respiratory symptom scores, and this association becomes stronger with worsening DLco, suggesting that impaired gas exchange alone has a significant negative impact on the quality of life in PWH. Additional studies are ongoing to understand the etiology of this finding and design appropriate interventions.
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Affiliation(s)
- Katerina L. Byanova
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Jessica Fitzpatrick
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Amanda K. Jan
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Maggie McGing
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Marlena Hartman-Filson
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Carly K. Farr
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
| | - Michelle Zhang
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Kendall Gardner
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Jake Branchini
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Robert Kerruish
- School of Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, United States of America
| | - Sharvari Bhide
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Aryana Bates
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Jenny Hsieh
- Department of Anesthesia and Perioperative Care, Division of Respiratory Care Services, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
| | - Rebecca Abelman
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Peter W. Hunt
- Department of Medicine, Division of Experimental Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Richard J. Wang
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Kristina A. Crothers
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, United States of America
| | - Laurence Huang
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, California, United States of America
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
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Ronit A, Omland LH, Kronborg G, Pedersen G, Nielsen L, Mohey R, Wiese L, Obel N, Ahlström MG. Incidence of chronic obstructive pulmonary disease in people with HIV, their parents and siblings in Denmark. J Infect Dis 2021; 225:492-501. [PMID: 34260725 DOI: 10.1093/infdis/jiab369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People with HIV (PWH) may be at increased risk of several respiratory syndromes including chronic obstructive pulmonary disease (COPD). In matched cohort studies, we examined risk factors for COPD in PWH, their parents and siblings compared with population controls. METHODS Using data from national registries, competing risk regression models were constructed and used to calculate adjusted hazard ratios (aHR) for COPD. We evaluated the effect of HIV characteristics, smoking and educational attainment on COPD incidence in PWH. RESULTS A total of 226 PWH and 1029 population controls were diagnosed with COPD during 63,661 and 562,171 person years of follow up. PWH had increased risk of being diagnosed with COPD compared to controls (aHR 2.02 [95%CI: 1.75-2.33]). Parents and siblings of PWH were also more likely to be diagnosed with COPD compared to controls. CD4+ T-cell counts were not associated with COPD, but both unsuppressed viral replication, smoking status and educational attainment were associated with COPD in PWH. No COPD diagnoses were registered in PWH with high educational attainment and absence of smoking. CONCLUSIONS PWH have an increased risk of being diagnosed with COPD, as have their parents and siblings. This seems to be driven primarily by smoking and low socioeconomic status.
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Affiliation(s)
- Andreas Ronit
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre,Denmark
| | - Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigsh ospitalet,Denmark
| | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre,Denmark
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg,Denmark
| | - Lars Nielsen
- Department of Infectious Diseases, Hillerød University Hospital, Hillerød,Denmark
| | - Rajesh Mohey
- Department of Infectious Diseases, Herning University Hospital, Herning,Denmark
| | - Lothar Wiese
- Department of Internal Medicine, Division of Infectious Diseases, Zealand University Hospital, Roskilde,Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigsh ospitalet,Denmark
| | - Magnus G Ahlström
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Denmark
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Byanova KL, Kunisaki KM, Vasquez J, Huang L. Chronic obstructive pulmonary disease in HIV. Expert Rev Respir Med 2021; 15:71-87. [PMID: 33167728 PMCID: PMC7856058 DOI: 10.1080/17476348.2021.1848556] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023]
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is more prevalent in people with HIV (PWH) than in the general population and leads to an increased burden of morbidity and mortality in this population. The mechanisms behind COPD development and progression in PWH are not fully elucidated, and there are no PWH-specific guidelines for COPD management. Areas covered: The goal of this broad narrative review is to review the epidemiology of COPD in PWH globally, highlight proposed pathways contributing to increased COPD prevalence and progression in PWH, discuss structural and functional changes in the lungs in this population, assesses the excess mortality and comorbidities in PWH with COPD, and address management practices for this unique population. Expert opinion: Understanding how a chronic viral infection leads to COPD, independent of cigarette smoking, is of critical scientific importance. Further research should focus on the pathophysiology of the interaction between HIV and COPD, and determine the role of disease-modifying risk factors such as opportunistic pneumonia and air pollution, as well as generate data from randomized clinical trials on the safety and efficacy of specific therapies for this vulnerable patient population.
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Affiliation(s)
- Katerina L Byanova
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ken M. Kunisaki
- Section of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Joshua Vasquez
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laurence Huang
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- HIV, Infectious Diseases, and Global Medicine Division, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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6
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Brown J, Pickett E, Smith C, Sachikonye M, Brooks L, Mahungu T, Lowe DM, Madge S, Youle M, Johnson M, Hurst JR, McHugh TD, Abubakar I, Lipman M. The effect of HIV status on the frequency and severity of acute respiratory illness. PLoS One 2020; 15:e0232977. [PMID: 32469981 PMCID: PMC7259631 DOI: 10.1371/journal.pone.0232977] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/24/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Antiretroviral therapy has improved the health of people living with HIV (PLW-HIV), though less is known about how this impacts on acute respiratory illness. These illnesses are a common cause of ill health in the general population and any increase in their frequency or severity in PLW-HIV might have significant implications for health-related quality of life and the development of chronic respiratory disease. Methods In a prospective observational cohort study following PLW-HIV and HIV negative participants for 12 months with weekly documentation of any acute respiratory illness, we compared the frequency, severity and healthcare use associated with acute respiratory illnesses to determine whether PLW-HIV continue to have a greater frequency or severity of such illnesses despite antiretroviral therapy. Results We followed-up 136 HIV positive and 73 HIV negative participants for 12 months with weekly documentation of any new respiratory symptoms. We found that HIV status did not affect the frequency of acute respiratory illness: unadjusted incidence rates per person year of follow-up were 2.08 illnesses (95% CI 1.81–2.38) and 2.30 illnesses (1.94–2.70) in HIV positive and negative participants respectively, IRR 0.87 (0.70–1.07) p = 0.18. However, when acute respiratory illnesses occurred, PLW-HIV reported more severe symptoms (relative fold-change in symptom score 1.61 (1.28–2.02), p <0.001) and were more likely to seek healthcare advice (42% vs 18% of illnesses, odds ratio 3.32 (1.48–7.39), p = 0.003). After adjustment for differences in baseline characteristics, PLW-HIV still had higher symptom scores when unwell. Conclusions HIV suppression with antiretroviral therapy reduces the frequency of acute respiratory illness to background levels, however when these occur, they are associated with more severe self-reported symptoms and greater healthcare utilisation. Exploration of the reasons for this greater severity of acute respiratory illness may allow targeted interventions to improve the health of people living with HIV. Trial registration ISRCTN registry (ISRCTN38386321).
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Affiliation(s)
- James Brown
- Division of Medicine, UCL Respiratory, University College London, London, England, United Kingdom
- Royal Free London NHS Foundation Trust, London, England, United Kingdom
- * E-mail:
| | - Elisha Pickett
- Royal Free London NHS Foundation Trust, London, England, United Kingdom
| | - Colette Smith
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, England, United Kingdom
| | - Memory Sachikonye
- UK-CAB, HIV Treatment Advocates Network, London, England, United Kingdom
| | - Lucy Brooks
- The Keats Group Practice, London, England, United Kingdom
| | - Tabitha Mahungu
- Royal Free London NHS Foundation Trust, London, England, United Kingdom
| | - David M. Lowe
- Royal Free London NHS Foundation Trust, London, England, United Kingdom
- Institute of Immunity and Transplantation, University College London, London, England, United Kingdom
| | - Sara Madge
- Royal Free London NHS Foundation Trust, London, England, United Kingdom
| | - Mike Youle
- Royal Free London NHS Foundation Trust, London, England, United Kingdom
| | - Margaret Johnson
- Royal Free London NHS Foundation Trust, London, England, United Kingdom
| | - John R. Hurst
- Division of Medicine, UCL Respiratory, University College London, London, England, United Kingdom
| | - Timothy D. McHugh
- Division of Infection & Immunity, UCL Centre for Clinical Microbiology, University College London, London, England, United Kingdom
| | - Ibrahim Abubakar
- Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, University College London, London, England, United Kingdom
| | - Marc Lipman
- Division of Medicine, UCL Respiratory, University College London, London, England, United Kingdom
- Royal Free London NHS Foundation Trust, London, England, United Kingdom
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Besutti G, Santoro A, Scaglioni R, Neri S, Zona S, Malagoli A, Orlando G, Beghè B, Ligabue G, Torricelli P, Manfredini M, Pellacani G, Fabbri LM, Guaraldi G. Significant chronic airway abnormalities in never-smoking HIV-infected patients. HIV Med 2019; 20:657-667. [PMID: 31577384 DOI: 10.1111/hiv.12785] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The aim of the study was to describe chronic lung disease in HIV-infected never-smokers by looking at clinical, structural and functional abnormalities. METHODS This comparative cross-sectional study included 159 HIV-infected never-smoking patients [mean (± standard deviation) age 54.6 ± 9.1 years; 13.2% female; 98.1% with undetectable viral load] and 75 nonmatched never-smoking controls [mean (± standard deviation) age 52.6 ± 6.9 years; 46.7% female]. We examined calcium scoring computer tomography (CT) scans or chest CT scans, all with a lung-dedicated algorithm reconstruction, to assess emphysema and airway disease (respiratory bronchiolitis and/or bronchial wall thickening), tested pulmonary function using spirometry, lung volumes and the diffusion lung capacity of carbon monoxide (DLCO), and assessed respiratory symptoms using the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT). RESULTS Twenty-five (17.2%) of the HIV-infected patients versus two (2.7%) of the controls had a CAT score > 10. Only 5% of the HIV-infected patients showed FEV1% < 80%, and 25% had DLCO < 75% of the predicted value. Based on the CT scans, they had increased prevalences, compared with the controls, of airway disease (37% versus 7.9%, respectively) and emphysema (18% versus 4%, respectively), with more severe and more frequent centrilobular disease. After correction for age, sex and clinical factors, HIV infection was significantly associated with CAT > 10 [odds ratio (OR) 7.7], emphysema (OR 4), airway disease (OR 4.5) and DLCO < 75% of predicted (OR 4). CONCLUSIONS Although comparisons were limited by the different enrolment methods used for HIV-infected patients and controls, the results suggest that never-smoking HIV-infected patients may present with chronic lung damage characterized by CT evidence of airway disease. A minority of them showed respiratory symptoms, without significant functional abnormalities.
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Affiliation(s)
- G Besutti
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Radiology Unit, AUSL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A Santoro
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - R Scaglioni
- Radiology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - S Neri
- University of Modena and Reggio Emilia, Modena, Italy
| | - S Zona
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - A Malagoli
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - G Orlando
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - B Beghè
- Respiratory Disease Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - G Ligabue
- Radiology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - P Torricelli
- Radiology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - M Manfredini
- Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - G Pellacani
- Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - L M Fabbri
- Respiratory Disease Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - G Guaraldi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
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Robertson TE, Nouraie M, Qin S, Crothers KA, Kessinger CJ, McMahon D, Chandra D, Kingsley LA, Greenblatt RM, Huang L, Fitzpatrick ME, Morris A. HIV infection is an independent risk factor for decreased 6-minute walk test distance. PLoS One 2019; 14:e0212975. [PMID: 31017909 PMCID: PMC6481785 DOI: 10.1371/journal.pone.0212975] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/12/2019] [Indexed: 11/18/2022] Open
Abstract
Background Ambulatory function predicts morbidity and mortality and may be influenced by cardiopulmonary dysfunction. Persons living with HIV (PLWH) suffer from a high prevalence of cardiac and pulmonary comorbidities that may contribute to higher risk of ambulatory dysfunction as measured by 6-minute walk test distance (6-MWD). We investigated the effect of HIV on 6-MWD. Methods PLWH and HIV-uninfected individuals were enrolled from 2 clinical centers and completed a 6-MWD, spirometry, diffusing capacity for carbon monoxide (DLCO) and St. George’s Respiratory Questionnaire (SGRQ). Results of 6-MWD were compared between PLWH and uninfected individuals after adjusting for confounders. Multivariable linear regression analysis was used to determine predictors of 6-MWD. Results Mean 6-MWD in PLWH was 431 meters versus 462 in 130 HIV-uninfected individuals (p = 0.0001). Older age, lower forced expiratory volume (FEV1)% or lower forced vital capacity (FVC)%, and smoking were significant predictors of decreased 6-MWD in PLWH, but not HIV-uninfected individuals. Lower DLCO% and higher SGRQ were associated with lower 6-MWD in both groups. In a combined model, HIV status remained an independent predictor of decreased 6-MWD (Mean difference = -19.9 meters, p = 0.005). Conclusions HIV infection was associated with decreased ambulatory function. Airflow limitation and impaired diffusion capacity can partially explain this effect. Subjective assessments of respiratory symptoms may identify individuals at risk for impaired physical function who may benefit from early intervention.
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Affiliation(s)
- Tom E. Robertson
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Mehdi Nouraie
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Shulin Qin
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Kristina A. Crothers
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, United States of America
| | - Cathy J. Kessinger
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Deborah McMahon
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Divay Chandra
- Department of Infectious disease and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Lawrence A. Kingsley
- Department of Infectious disease and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Ruth M. Greenblatt
- Department of Clinical Pharmacy, University of California at San Francisco, San Francisco, California, United States of America
| | - Laurence Huang
- Department of Medicine, Division of Pulmonary and Critical Care Medicine and HIV, Infectious Diseases and Global Medicine Division, University of California San Francisco, San Francisco, California, United States of America
| | - Meghan E. Fitzpatrick
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Alison Morris
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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Verboeket SO, Wit FW, Kirk GD, Drummond MB, van Steenwijk RP, van Zoest RA, Nellen JF, Schim van der Loeff MF, Reiss P, Reiss P, Wit FWNM, van der Valk M, Schouten J, Kooij KW, van Zoest RA, Verheij E, Verboeket SO, Elsenga BC, Prins M, van der Loeff MFS, del Grande L, Olthof V, Dijkstra M, Zaheri S, Hillebregt MMJ, Ruijs YMC, Benschop DP, el Berkaoui A, Kootstra NA, Harskamp-Holwerda AM, Maurer I, Mangas Ruiz MM, Girigorie AF, Boeser-Nunnink B, Zikkenheiner W, Janssen FR, Geerlings SE, Goorhuis A, Hovius JWR, Nellen FJB, van der Poll T, Prins JM, Reiss P, van der Valk M, Wiersinga WJ, van Vugt M, de Bree G, van Eden J, van Hes AMH, Pijnappel FJJ, Weijsenfeld A, Smalhout S, van Duinen M, Hazenberg A, Postema PG, Bisschop PHLT, Serlie MJM, Lips P, Dekker E, van der Velde N, Willemsen JMR, Vogt L, Schouten J, Portegies P, Schmand BA, Geurtsen GJ, Verbraak FD, Demirkaya N, Visser I, Schadé A, Nieuwkerk PT, Langebeek N, van Steenwijk RP, Dijkers E, Majoie CBLM, Caan MWA, van Lunsen HW, Nievaard MAF, van den Born BJH, Stroes ESG, Mulder WMC, van Oorspronk S. Reduced Forced Vital Capacity Among Human Immunodeficiency Virus-Infected Middle-Aged Individuals. J Infect Dis 2018; 219:1274-1284. [DOI: 10.1093/infdis/jiy653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/08/2018] [Indexed: 02/01/2023] Open
Affiliation(s)
- Sebastiaan O Verboeket
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Ferdinand W Wit
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Greg D Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - M Bradley Drummond
- Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill
| | | | - Rosan A van Zoest
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Jeannine F Nellen
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maarten F Schim van der Loeff
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, The Netherlands
| | - Peter Reiss
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, The Netherlands
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Abstract
: HIV in the antiretroviral therapy era is characterized by multimorbidity and the frequent occurrence of HIV-associated non-AIDS chronic health conditions. Respiratory symptoms and chronic pulmonary diseases, including chronic obstructive pulmonary disease, asthma, and cardiopulmonary dysfunction, are among the conditions that may present in persons living with HIV. Tobacco smoking, which is disproportionately high among persons living HIV, strongly contributes to the risk of pulmonary disease. Additionally, features associated with and at times unique to HIV, including persistent inflammation, immune cell activation, oxidative stress, and dysbiosis, may also contribute. This review summarizes the available literature regarding epidemiology of and risk factors for respiratory symptoms and chronic pulmonary disease in the current era.
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Airflow limitation in people living with HIV and matched uninfected controls. Thorax 2018; 73:431-438. [DOI: 10.1136/thoraxjnl-2017-211079] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 12/13/2017] [Accepted: 12/22/2017] [Indexed: 11/03/2022]
Abstract
IntroductionWhether HIV influences pulmonary function remains controversial. We assessed dynamic pulmonary function in people living with HIV (PLWHIV) and uninfected controls.MethodsA total of 1098 PLWHIV from the Copenhagen Co-morbidity in HIV infection study and 12 161 age-matched and sex-matched controls from the Copenhagen General Population Study were included. Lung function was assessed using FEV1 and FVC, while airflow limitation was defined by the lower limit of normal (LLN) of FEV1/FVC and by FEV1/FVC<0.7 with FEV1predicted <80% (fixed). Logistic and linear regression models were used to determine the association between HIV and pulmonary function adjusting for potential confounders (including smoking and socioeconomic status).ResultsIn predominantly white men with mean (SD) age of 50.6 (11.1) the prevalence of airflow limitation (LLN) was 10.6% (95% CI 8.9% to 12.6%) in PLWHIV and 10.6% (95% CI 10.0 to 11.1) in uninfected controls. The multivariable adjusted OR for airflow limitation defined by LLN for HIV was 0.97 (0.77–1.21, P<0.78) and 1.71 (1.34–2.16, P<0.0001) when defined by the fixed criteria. We found no evidence of interaction between HIV and cumulative smoking in these models (P interaction: 0.25 and 0.17 for LLN and fixed criteria, respectively). HIV was independently associated with 197 mL (152–242, P<0.0001) lower FEV1 and 395 mL (344–447, P<0.0001) lower FVC, and 100 cells/mm3 lower CD4 nadir was associated with 30 mL (7–52, P<0.01) lower FEV1 and 51 mL (24–78, P<0.001) lower FVC.ConclusionHIV is a risk factor for concurrently decreased FEV1 and FVC. This excess risk is not explained by smoking or socioeconomic status and may be mediated by prior immunodeficiency.Trial registration numberNCT02382822.
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