by
Monica Campo;
Kisann K. Oursler;
Laurence Huang;
Matthew Goetz;
David Rimland;
Guy Soo Hoo;
Sheldon Brown;
Maria Rodriguez-Barradas;
David Au;
Kathleen M. Akguen;
Shahida Shahrir;
Kristina Crothers
Objective: Chronic lung disease has been associated with greater impairment in self-reported physical function in HIV-infected patients. We sought to study this association using objective measures of physical function and pulmonary function.
Design: Baseline data from the Examinations of HIV Associated Lung Emphysema study, a multicenter observational cohort of HIVinfected and uninfected veterans.
Methods: We assessed the association between clinical, laboratory, and pulmonary function measures with 6-minute walk test (6-MWT). Multivariable linear regression models were generated to identify factors associated with 6-MWT performance.
Results: Three hundred forty participants completed 6-MWT (mean age 55 years), with 68% blacks, 94% men, and 62% current smokers. Overall, 180 (53%) were HIV-infected and 63 (19%) had spirometry-defined chronic obstructive pulmonary disease. In a multivariable model, age, current smoking, and obesity (body mass index < 30) were independently associated with lower 6-MWT performance, but HIV infection was not; there was a significant interaction between HIV and chronic cough, such that distance walked among HIV-infected participants with chronic cough was 51.76 m less (P = 0.04) compared with those without cough or HIV. Among HIV-infected participants, the forced expiratory volume in 1 second (FEV1, percent predicted), to a greater extent than total lung capacity or diffusing capacity, attenuated the association with chronic cough; decreased FEV1 was independently associated with lower 6-MWT performance in those with HIV.
Conclusions: Older age, current smoking, and airflow limitation were important determinants of 6-MWT performance in the HIVinfected participants. These findings suggest that potential interventions to improve physical function may include early management of respiratory symptoms and airflow limitation.
by
Matthew Triplette;
Engi Attia;
Kathleen Akgun;
Monica Campo;
Maria Rodriguez-Barradas;
Sudhakar Pipavath;
Shahida Shahrir;
Cherry Wongtrakool;
Matthew Bidwell Goetz;
Joon Kim;
Guy W. Soo Hoo;
Sheldon T. Brown;
Kristina Crothers
Background: Emphysema is more prevalent in HIV-infected (HIV+) patients independent of smoking behavior. Nonetheless, health effects of emphysema in this population are poorly understood. We determined whether emphysema is associated with a greater burden of pulmonary symptoms and a lower 6-minute walk distance (6MWD) in HIV+ compared with HIV-uninfected (HIV-) subjects. Methods: We performed a cross-sectional analysis of 170 HIV+ and 153 HIV- subjects in the Examinations of HIV-Associated Lung Emphysema (EXHALE) cohort study. Subjects completed a self-assessment of respiratory symptoms, pulmonary function testing, and 6MWD testing as well as a chest computed tomography to determine emphysema severity. We used regression models to determine the association of emphysema with respiratory symptoms and 6MWD in HIV+ subjects and compared this to HIV- subjects. Results: Models stratified by HIV status demonstrated an association between > 10% radiographic emphysema and chronic cough and/or phlegm and 6MWD in HIV+ subjects. These associations persisted among the subset without airflow obstruction: those with emphysema had 4.2 (95% confidence interval: 1.3 to 14) times the odds of chronic cough and/or phlegm and walked 60 m (95% confidence interval: 26 to 93) less distance than those without emphysema. There was no association between > 10% emphysema and symptoms or 6MWD in HIV- subjects. Conclusions: In our cohort, > 10% radiographic emphysema was associated with chronic cough and/or phlegm and lower 6MWD in HIV+ but not HIV- subjects. These findings were robust even among HIV+ subjects with milder forms of emphysema and those without airflow obstruction, highlighting the clinical impact of emphysema in these patients.