We sought to evaluate whether people living with HIV (PLWH) using effective antiretroviral therapy (ART) have worse respiratory health status than similar HIV-negative individuals. MethodsWe recruited 197 HIV-positive and 93 HIV-negative adults from HIV and sexual health clinics. They completed a questionnaire regarding risk factors for respiratory illness. Respiratory health status was assessed using the St George's Respiratory Questionnaire (SGRQ) and the Medical Research Council (MRC) breathlessness scale. Subjects underwent spirometry without bronchodilation. ResultsPLWH had worse respiratory health status: the median SGRQ Total score was 12 [interquartile range (IQR) 6-25] in HIV-positive subjects vs. 6 (IQR 2-14) in HIV-negative subjects (P < 0.001); breathlessness was common in the HIV-positive group, where 47% compared with 24% had an MRC breathlessness score ≥ 2 (P = 0.001). Eighteen (11%) HIV-positive and seven (9%) HIVnegative participants had airflow obstruction. In multivariable analyses (adjusted for age, gender, smoking, body mass index and depression), HIV infection remained associated with higher SGRQ and MRC scores, with an adjusted fold-change in SGRQ Total score of 1.54 [95% confidence interval (CI) 1.14-2.09; P = 0.005] and adjusted odds ratio of having an MRC score of ≥ 2 of 2.45 (95% CI 1.15-5.20; P = 0.02). Similar findings were obtained when analyses were repeated including only HIV-positive participants with a viral load < 40 HIV-1 RNA copies/mL. ConclusionsDespite effective ART, impaired respiratory health appears more common in HIV-positive adults, and has a significant impact on health-related quality of life.
BackgroundThe widespread use of antiretroviral therapy (ART) has led to a reduction in HIV related opportunistic infections. An increase in chronic non-HIV related co-morbidities has been observed in stable HIV positive individuals receiving ART. The extent to which HIV infection remains an independent risk factor for respiratory disease despite the use of antiretroviral therapy is uncertain and few studies have systematically evaluated respiratory disease in HIV-infected populations with access to antiretroviral therapy.AimsWe sought to evaluate the frequency of (a) smoking and (b) respiratory symptoms and (c) spirometric impairment in the ambulatory UK adult HIV infected population, compared to HIV uninfected controls.MethodsHIV-positive participants were recruited from a large HIV care service, HIV uninfected participants were recruited from Sexual Health services (where recruitment was stratified by age to approximate that of the HIV positive subjects). Participants completed a questionnaire which included questions on smoking history and respiratory health status using the St George’s Respiratory Questionnaire (SGRQ), and undertook spirometry without bronchodilation.Results249 participants were recruited between April and July 2015 (Table 1). 28% of HIV positive and 33% of HIV negative participants were current smokers (p = 0.22). 9% of HIV positive and 7% of HIV negative participants had an FEV1/FVC of <0.7 (p = 0.38). 92% of HIV positive participants were using antiretroviral therapy, 86% had an undetectable plasma HIV viral load and mean CD4 count was 684 cells/µL.Abstract P226 Table 1 HIV positive (N = 181)HIV negative (N = 68)Age [years]50 (43–56)44 (38–52)P = 0.006Using antiretroviral therapy92%CD4 count [cells/µL]617 (458–839)Male79%68%P = 0.065Current smoker28%33%P = 0.22FEV13.43 (0.86)*3.20 (0.78)*P = 0.08FVC4.24 (1.06)*3.87 (0.98)* P = 0.02FEV1/FVC <0.79%7%P = 0.55SGRQTotal score12 (6–29)8 (3–18) P = 0.032Values median (IQR) or% unless otherwise stated. *mean (SD).Significantly higher SGRQ scores were observed in HIV positive participants than HIV-negative participants with a median total SGRQ score of 12 for those with HIV infection and 8 for the HIV negative participants (p = 0.03). In a linear regression (log scale) model, HIV infection was associated with a 62% increase (95% CI 1.19–2.21, p < 0.01) in SGRQ in unadjusted analysis and 48% increase (1.08–2.02, p = 0.01) in a multivariable analysis adjusting for age, gender and smoking status.ConclusionsDespite widespread use of ART, HIV infection is independently associated with impaired respiratory health status. This does not appear to result from current smoking or obstructive lung disease.
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