Brief Report: Systemic Inflammation, Immune Activation, and Impaired Lung Function Among People Living With HIV in Rural Uganda

North, Crystal M.; Muyanja, Daniel; Kakuhikire, Bernard; Tsai, Alexander C.; Tracy, Russell P.; Hunt, Peter W.; Kwon, Douglas S.; Christiani, David C.; Okello, Samson; Siedner, Mark J.

doi:10.1097/qai.0000000000001711

Cited by 18 publications

(22 citation statements)

References 49 publications

(48 reference statements)

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“…Based upon similarities in their relationships with systemic inflammation [7, 60] and lung disease [57, 62–64], chronic HIV infection and air pollution may act synergistically to worsen respiratory morbidity among co-exposed populations. Indeed, we previously found that systemic inflammation varied according to both biomass use and HIV serostatus in this cohort, and that higher indices of systemic inflammation were associated with worse lung function among both PLWH and HIV-uninfected controls [65]. Alternatively, air pollution exposure may increase the risk of pulmonary tuberculosis through smoke-induced endothelial and alveolar damage that facilitates mycobacterial infection [8, 66] and/or altered antimycobacterial innate immunity [67].…”

Section: Discussionmentioning

confidence: 99%

Personal carbon monoxide exposure, respiratory symptoms, and the potentially modifying roles of sex and HIV infection in rural Uganda: a cohort study

et al. 2019

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Background Most of the global burden of pollution-related morbidity and mortality is believed to occur in resource-limited settings, where HIV serostatus and sex may influence the relationship between air pollution exposure and respiratory morbidity. The lack of air quality monitoring networks in these settings limits progress in measuring global disparities in pollution-related health. Personal carbon monoxide monitoring may identify sub-populations at heightened risk for air pollution-associated respiratory morbidity in regions of the world where the financial cost of air quality monitoring networks is prohibitive. Methods From September 2015 through May 2017, we measured 48-h ambulatory carbon monoxide (CO) exposure in a longitudinal cohort of HIV-infected and uninfected adults in rural southwestern Uganda. We fit generalized mixed effects models to identify correlates of CO exposure exceeding international air quality thresholds, quantify the relationship between CO exposure and respiratory symptoms, and explore potential effect modification by sex and HIV serostatus. Results Two hundred and sixty study participants completed 419 sampling periods. Personal CO exposure exceeded international thresholds for 50 (19%) participants. In covariate-adjusted models, living in a home where charcoal was the main cooking fuel was associated with CO exposure exceeding international thresholds (adjusted odds ratio [AOR] 11.3, 95% confidence interval [95%CI] 4.7–27.4). In sex-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among women (AOR 3.3, 95%CI 1.1–10.0) but not men (AOR 1.3, 95%CI 0.4–4.4). In HIV-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among HIV-infected (AOR 2.5, 95%CI 1.01–6.0) but not HIV-uninfected (AOR 1.4, 95%CI 0.1–14.4) participants. Conclusions In a cohort in rural Uganda, personal CO exposure frequently exceeded international thresholds, correlated with biomass exposure, and was associated with respiratory symptoms among women and people living with HIV. Our results provide support for the use of ambulatory CO monitoring as a low-cost, feasible method to identify subgroups with heightened vulnerability to pollution-related respiratory morbidity in resource-limited settings and identify subgroups that may have increased susceptibility to pollution-associated respiratory morbidity. Electronic supplementary material The online version of this article (10.1186/s12940-019-0517-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Personal carbon monoxide exposure, respiratory symptoms, and the potentially modifying roles of sex and HIV infection in rural Uganda: a cohort study

et al. 2019

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“…In several of the included studies, sample size or power calculations are not included, limiting the external validity of their findings. Four of the included studies were at risk of observer bias due to the lack of reported blinding of the investigators, radiologists or interpreters [36,38–40]. In addition, several studies are at risk of sampling bias [35,36,40].…”

Section: Resultsmentioning

confidence: 99%

“…Four of the included studies were at risk of observer bias due to the lack of reported blinding of the investigators, radiologists or interpreters [36,38–40]. In addition, several studies are at risk of sampling bias [35,36,40]. In North et al , groups were chosen by convenience sampling [40], while in Attia and Triplette [35,37], patients were chosen from a veteran population, which limits the generalizability of these results [35,37].…”

Section: Resultsmentioning

confidence: 99%

“…In addition, several studies are at risk of sampling bias [35,36,40]. In North et al , groups were chosen by convenience sampling [40], while in Attia and Triplette [35,37], patients were chosen from a veteran population, which limits the generalizability of these results [35,37]. The study by Crothers et al is at risk of confounding since they had limited ability to adjust for multiple covariates and confounders within their groups [41].…”

Section: Resultsmentioning

confidence: 99%

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Inflammatory mediators and lung abnormalities in HIV: A systematic review

et al. 2019

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HIV and pneumonia infections have both been shown to negatively impact lung function. However, evidence of the role of inflammation on lung dysfunction in HIV and pneumonia co-infected individuals remains limited. We aimed to systematically review the association of inflammatory markers and lung abnormalities in HIV and pneumonia co-infected individuals. This systematic review was registered with the International Prospective Register of Systematic Reviews on August 15, 2017 (registration number CRD42017069254) and used 4 databases (Cochrane Central Register of Controlled Trials, PubMed Central, Clinical Trials.gov and Google Scholar). All clinical trial, observational, and comparative studies targeting adult (> 18 years old) populations with HIV, pneumonia, or both, that report on immune response (cytokine, chemokine, or biomarker), and lung abnormality as an outcome were eligible. Data selection, risk of bias and extraction were performed independently by 2 blinded reviewers. Due to heterogeneity among the articles, a qualitative synthesis was performed. Our search strategy identified 4454 articles of which, 7 met our inclusion criteria. All of the studies investigated the ability of circulating biomarkers to predict lung damage in HIV. None of the articles included patients with both HIV and pneumonia, nor pneumonia alone. Markers of inflammation (IL-6, TNF-α, CRP), innate defense (cathelicidin), monocyte and macrophage activation (sCD14, sCD163 and, IL-2sRα), endothelial dysfunction (ET-1) and general immune health (CD4/CD8 ratio) were associated with lung abnormalities in HIV. This review highlights the lack of available information regarding the impact of inflammatory mediators on lung function in HIV and pneumonia populations, therefore opportunities to prevent lung damage with available anti-inflammatory treatment or to investigate new ones still remain.

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“…It is also known to cause many extra-hepatic manifestations including auto-immune thyroid disease 16. Impaired lung functions have also been demonstrated in HIV infection and fatty liver disease 17,18. HCV produces many inflammatory mediators including TNF-α, TGF-β, interleukin (IL-6), and IL-8 by altering cellular signalling and genetic imbalances 19.…”

Section: Discussionmentioning

confidence: 99%

Non-specific impairment of Lung Function on Spirometery in Patients with Chronic Hepatitis-C

Zuberi

Rasheed

et al. 2019

Pak J Med Sci

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Objectives: To document frequency of non-specific impairment of lung functions (NILF) in patients of HCV and to compare according to gender, genotype, liver fibrosis score and smoking status. Methods: Patients of chronic hepatitis C were included after informed consent. Demographic data was recorded, and they underwent baseline investigations, fibroscan, abdominal ultrasound and PFT. Patients were segregated on basis of gender, fibroscan stages and smoking status. NILF was labelled if any two of three criteria are fulfilled (a) FVC <80% of Predicted, (b) FEV1 <80% Predicted, (c) FEV1/FVC ≥70. Results: Two hundred thirty four patients were of chronic HCV who fulfilled the selection criteria were inducted in study. These included 49.6% males and 50.4% females. There were 15.0% smokers, 16.2% were ex-smokers while 68.8% were never smokers. NILF was present in 130 (55.6%) out of which 61.5% were female and 38.5% were male (p <0.001), its presence in smokers was 56.2% and in never smokers was 55.3% (p=0.507). Presence of NILF increased with Fibroscan stages from F1 to F4 (p <0.001). Conclusions: NILF pattern on spirometry with normal chest radiograph is common among HCV patients. It was found more common in females and frequency increased progressively with fibro scan stages. How to cite this:Zuberi FF, Zuberi BF, Rasheed T, Nawaz Z. Non-specific impairment of Lung Function on Spirometery in patients with Chronic Hepatitis-C. Pak J Med Sci. 2019;35(2):---------. doi: https://doi.org/10.12669/pjms.35.2.73 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Brief Report: Systemic Inflammation, Immune Activation, and Impaired Lung Function Among People Living With HIV in Rural Uganda

Abstract: Macrophage activation and systemic inflammation are associated with lower lung function among PLWH on stable ART in rural Uganda. Future work should focus on underlying mechanisms and public health implications.

Cited by 18 publications

References 49 publications

Personal carbon monoxide exposure, respiratory symptoms, and the potentially modifying roles of sex and HIV infection in rural Uganda: a cohort study

Personal carbon monoxide exposure, respiratory symptoms, and the potentially modifying roles of sex and HIV infection in rural Uganda: a cohort study

Inflammatory mediators and lung abnormalities in HIV: A systematic review

Non-specific impairment of Lung Function on Spirometery in Patients with Chronic Hepatitis-C

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