Pulmonary restriction predicts long-term pulmonary impairment in people with HIV and tuberculosis

• Type of Material: Article
• Authors: Sara Auld, Emory University; Hardy Kornfeld, University of Massachusetts Medical School; Pholo Maenetje, The Aurum Institute; Mandla Mlotshwa, The Aurum Institute; William Chase, University of Pennsylvania; Mboyo di-Tamba Vangu, University of Witwatersrand; Drew A. Torigian, University of Pennsylvania; Robert S. Wallis, The Aurum Institute; Gavin Churchyard, The Aurum Institute; Gregory P. Bisson, University of Pennsylvania
• Language: English
• Date: 2021-01-07
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2020.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12890-020-01368-4
• Title of Journal or Parent Work: BMC PULMONARY MEDICINE
• Volume: 21
• Issue: 1
• Start Page: 19
• End Page: 19
• Grant/Funding Information: This work was supported by a K23 award to SCA (K23AI134182) and by an R01 grant awarded to GPB (R01AI120821) by the National Institute of Allergy and Infectious Diseases (https://www.niaid.nih.gov/). This work was also supported by the Centers for AIDS Research at the University of Pennsylvania (P30AI045008) and Emory University (P30AI050409). Grants from Advancing Care & Treatment for TB/HIV (ACT4TB/HIV) (http://act4tbhiv.org/) were awarded to RSW and GC.
• Keywords: HIV; Science & Technology; MORTALITY; Life Sciences & Biomedicine; Respiratory System; Tuberculosis; ANTIRETROVIRAL THERAPY; NUTRITION EXAMINATION SURVEY; DISEASE; FIBROSIS; RISK; SPIROMETRY; 1ST NATIONAL-HEALTH; LUNG-FUNCTION; Respiratory function tests; Pulmonary disease
• Research Categories: Biology, Virology; Health Sciences, Nutrition; Health Sciences, Public Health

Abstract

Background: While tuberculosis is considered a risk factor for chronic obstructive pulmonary disease, a restrictive pattern of pulmonary impairment may actually be more common among tuberculosis survivors. We aimed to determine the nature of pulmonary impairment before and after treatment among people with HIV and tuberculosis and identify risk factors for long-term impairment. Methods: In this prospective cohort study conducted in South Africa, we enrolled adults newly diagnosed with HIV and tuberculosis who were initiating antiretroviral therapy and tuberculosis treatment. We measured lung function and symptoms at baseline, 6, and 12 months. We compared participants with and without pulmonary impairment and constructed logistic regression models to identify characteristics associated with pulmonary impairment. Results: Among 134 participants with a median CD4 count of 110 cells/μl, 112 (83%) completed baseline spirometry at which time 32 (29%) had restriction, 13 (12%) had obstruction, and 9 (7%) had a mixed pattern. Lung function was dynamic over time and 30 (33%) participants had impaired lung function at 12 months. Baseline restriction was associated with greater symptoms and with long-term pulmonary impairment (adjusted odds ratio 5.44, 95% confidence interval 1.16–25.45), while baseline obstruction was not (adjusted odds ratio 1.95, 95% confidence interval 0.28–13.78). Conclusions: In this cohort of people with HIV and tuberculosis, restriction was the most common, symptomatic, and persistent pattern of pulmonary impairment. These data can help to raise awareness among clinicians about the heterogeneity of post-tuberculosis pulmonary impairment, and highlight the need for further research into mediators of lung injury in this vulnerable population.