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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e3182a9215a
Clinical Science

HIV Infection Is Associated With Reduced Pulmonary Diffusing Capacity

Crothers, Kristina MD*; McGinnis, Kathleen MS; Kleerup, Eric MD; Wongtrakool, Cherry MD§; Hoo, Guy S. MD; Kim, Joon MD; Sharafkhaneh, Amir MD#; Huang, Laurence MD**; Luo, Zhaoyu PhD††; Thompson, Bruce PhD††; Diaz, Philip MD‡‡; Kirk, Gregory D. MD, PhD§§; Rom, William MD‖‖; Detels, Roger MD; Kingsley, Lawrence MD¶¶; Morris, Alison MD, MS##

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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.

© 2013 by Lippincott Williams & Wilkins

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