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HIV is associated with airway obstruction: a matched controlled study

Makinson, Alaina,b; Hayot, Mauricec; Eymard-Duvernay, Sabrinaa; Ribet, Célined; Raffi, Françoise; Pialoux, Gillesf; Zucman, Davidg; Poizot-Martin, Isabelleh; Bonnet, Fabricei; Abgrall, Sophiej; Tattevin, Pierrek; Cheret, Antoinel; Ferry, Tristanm; Mauboussin, Jean-Marcn; Marchand, Lucieo; Rouzaud, Clairep; Reynes, Jacquesa,b; Zins, Maried; Le Moing, Vincenta,bfor the ANRS EP48 HIV CHEST study Team

doi: 10.1097/QAD.0000000000001691

Objective: To explore whether airway obstruction is associated with HIV in a cohort of HIV-infected and uninfected smokers.

Methods: People living with HIV (PLWHIV) participated in the ANRS EP48 HIV CHEST study, an early lung cancer diagnosis study with low-dose chest tomography. HIV-uninfected study participants were from the CONSTANCES cohort. Inclusion criteria were an age greater than 40 years, a smoking history of at least 20 pack-years, and for PLWHIV, a CD4+ T-lymphocyte nadir less than 350/μl and last CD4+ cell count more than 100 cells/μl. Two randomly selected HIV-uninfected study participants were matched by age and sex with one PLWHIV. Prebronchodilatator forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio was the primary outcome, and association of FEV1/FVC ratio less than 0.70 and FEV1 less than 80% of the theoretical value, as a proxy of chronic obstructive pulmonary disease, the secondary outcome.

Results: In total, 351 PLWHIV and 702 HIV-uninfected study participants were included. Median age was 50 years, and 17% of study participants were women. Plasma HIV RNA was less than 50 copies/ml in 89% of PLWHIV, with a median CD4+ cell count of 573 cells/μl. HIV (β −2.19), age (per 10 years increase; β −2.81), tobacco use (per 5 pack-years increase; β −0.34), and hepatitis C virus serology (β−2.50) were negatively associated with FEV1/FVC. HIV [odds ratio (OR: 1.72)], age (per 10 years increase; OR 1.77), and tobacco use (per 5 pack-years increase; OR 1.11) were significantly associated with the secondary outcome.

Conclusion: Our study found a significant association of airway obstruction with HIV status in smokers aged more than 40 years with previous immunodeficiency.

aInfectious and Tropical Diseases Department, University Hospital Montpellier

bUMI 233/INSERMU1175, IRD, University Montpellier

cDepartment of Clinical Physiology, INSERM U-1046, University Hospital Montpellier 1, University of Montpellier, Montpellier

dUMS 11 INSERM-UVSQ, ‘Cohortes épidémiologiques en Population’, Villejuif

eCIC 1413, INSERM, University Hospital, Nantes

fInfectious and Tropical Diseases Department, University Hospital Tenon, UPMC, Paris

gHIV Department, AP-HP, Foch Hospital Suresnes, Suresnes

hImmuno-Hematology Clinic, APHM Sainte-Marguerite Hospital, Aix-Marseille University/SESSTIM, Marseille

iInternal Medicine and Infectious Diseases Department, INSERM U1219, University Hospital Bordeaux, Bordeaux

jDepartment of Internal Medicine, AP-HP, Antoine Béclère Hospital, Clamart

kInfectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes

lInfectious Diseases Department, Tourcoing Hospital, Tourcoing

mUniversity Hospital de la Croix Rousse, Lyon

nInfectious and Tropical Diseases Unit, Nîmes University Hospital, Nîmes

oFrance Recherche Nord et Sud Sida-HIV et Hépatites

pDepartment of Infectious Diseases and Tropical Medicine, Infectiology Centre Necker-Pasteur, AP-HP, Necker-Enfants Malades Hospital, Paris, France.

Correspondence to Alain Makinson, MD, PhD, University Hospital Montpellier, 80 avenue Augustin Fliche, 34295 Montpellier, Cedex 5, France. E-mail:

Received 7 July, 2017

Revised 20 September, 2017

Accepted 30 September, 2017

Copyright © 2018 Wolters Kluwer Health, Inc.