HIV Infection Is Associated With Reduced Pulmonary Diffusing Capacity

Author:

Crothers, Kristina   McGinnis, Kathleen   Kleerup, Eric   Wongtrakool, Cherry   Hoo, Guy S.   Kim, Joon   Sharafkhaneh, Amir   Huang, Laurence   Luo, Zhaoyu   Thompson, Bruce   Diaz, Philip   Kirk, Gregory D.   Rom, William   Detels, Roger   Kingsley, Lawrence   Morris, Alison  

Journal:

JAIDS Journal of Acquired Immune Deficiency Syndromes

Issue Date:

2013

Abstract(summary):

Introduction: Prior studies comparing abnormalities in pulmonary function between HIV-infected and HIV-uninfected persons in the current era are limited. Objectives: To determine the pattern and severity of impairment in pulmonary function in HIV-infected compared with HIV-uninfected individuals. Methods: Cross-sectional analysis of 300 HIV-infected men and 289 HIV-uninfected men enrolled from 2009 to 2011 in 2 clinical centers of the Lung HIV Study. Participants completed pre- and postbronchodilator spirometry, diffusing capacity of the lung for carbon monoxide (DLCO) measurement, and standardized questionnaires. Results: Most participants had normal airflow; 18% of HIV-infected and 16% of HIV-uninfected men had airflow obstruction. The mean percent predicted DLCO was 69% in HIV-infected vs. 76% in HIV-uninfected men (P < 0.001). A moderately to severely reduced DLCO of <= 60% was observed in 30% of HIV-infected compared with 18% of HIV-uninfected men (P < 0.001), despite the fact that 89% of those with HIV were on antiretroviral therapy. A reduced DLCO was significantly associated with HIV and CD4 cell count in linear regression adjusting for smoking and other confounders. The DLCO was lowest in HIV-infected men with CD4 cell counts < 200 cells per microliter compared with those with CD4 cell counts >= 200 cells per microliter and to HIV-uninfected men. Respiratory symptoms of cough, phlegm and dyspnea were more prevalent in HIV-infected patients particularly those with abnormal pulmonary function compared with HIV-uninfected patients. Conclusions: HIV infection is an independent risk factor for reduced DLCO, particularly in individuals with a CD4 cell count below 200 cells per microliter. Abnormalities in pulmonary function among HIV-infected patients manifest clinically with increased respiratory symptoms. Mechanisms accounting for the reduced DLCO require further evaluation.

Page:

271-278