Share this article on:

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##

JAIDS Journal of Acquired Immune Deficiency Syndromes: November 1st, 2013 - Volume 64 - Issue 3 - p 271–278
doi: 10.1097/QAI.0b013e3182a9215a
Clinical Science

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.

Supplemental Digital Content is Available in the Text.

*Department of Medicine, University of Washington, Seattle, WA;

Department of Medicine, University of Pittsburgh, Pittsburgh, PA;

Department of Medicine, University of California, Los Angeles, Los Angeles, CA;

§Department of Medicine, Atlanta Veterans Affairs Medical Center (VAMC) and Emory University, Atlanta, GA;

Department of Medicine, West Los Angeles VAMC and David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA;

Department of Medicine, James J. Peters Bronx VAMC, Bronx, NY;

#Department of Medicine, Michael E. DeBakey Houston VAMC and Baylor College of Medicine, Houston, TX;

**Department of Medicine, University of California, San Francisco, San Francisco, CA;

††Department of Medicine, Clinical Trials and Survey Corporation, Owings Mills, MD;

‡‡Department of Medicine, Ohio State University Medical Center, Columbus, OH;

§§Department of Medicine, Johns Hopkins University, Baltimore, MD;

‖‖Department of Medicine, New York University School of Medicine, New York, NY;

¶¶Departments of Infectious Diseases and Microbiology; and Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; and

##Departments of Medicine and Immunology, University of Pittsburgh, Pittsburgh, PA.

Correspondence to: Kristina Crothers, MD, University of Washington, Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104 (e-mail:

Supported by NIH/NHLBI R01-HL090342 (K.C.); K24-HL087713 (L.H.); HL090335 (L.H.); R01-HL090313 (P.T.D.), R01-HL090483 (G.K.), R01-HL090316 (W.N.R.), R01-HL090331 (B.W.T.), R01-HL090339 (A.M.).

Presented in part, at the Conference on Retrovirus and Opportunistic Infections (CROI), March 7, 2012, Seattle, WA.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received April 21, 2013

Accepted August 01, 2013

© 2013 by Lippincott Williams & Wilkins