HIV Infection Is Associated With Reduced Pulmonary Diffusing Capacity

• Authors: Kristina McGinnis, University of Pittsburgh; Kathleen Kleerup, University of California, Los Angeles; Eric Wongtrakool, Emory University; Kristina Crothers, University of Washington; Guy Soo Hoo, West Greater Veterans Affairs Medical Center; Joon Kim, James J. Peters Veterans Affairs Medical Center; Amir Sharafkhaneh, Michael E DeBakey Veterans Affairs Medical Center; Laurence Huang, University of California, San Francisco; Zhaoyu Luo, Clinical Trials and Survey Corporation; Bruce Thompson, Clinical Trials and Survey Corporation; Philip Diaz, Ohio State University; Gregory D. Kirk, Johns Hopkins University; William Rom, New York University; Roger Detels, University of California, Los Angeles; Lawrence Kingsley, University of Pittsburgh; Alison Morris, University of Pittsburgh
• Journal Title: Journal of Acquired Immune Deficiency Syndromes
• Volume: Volume 64, Number 3
• Publisher: Lippincott, Williams & Wilkins | 2013-11-01, Pages 271-278
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/QAI.0b013e3182a9215a
• Subjects: Health Sciences, Medicine and Surgery; Biology, Virology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; pulmonary function; FEV1; DLCO; gas exchange; COPD; HIV/AIDS; HUMAN-IMMUNODEFICIENCY-VIRUS; COMBINATION ANTIRETROVIRAL THERAPY; MULTICENTER AIDS COHORT; VETERANS AGING COHORT; LUNG-FUNCTION; RESPIRATORY SYMPTOMS; NATIONAL SAMPLE; FUNCTION TESTS; US ADULTS; HAART ERA

Abstract

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.