Decreased Lung Function and All-Cause Mortality in HIV-infected Individuals

Abstract

Airflow obstruction and impaired diffusing capacity appear to be associated with all-cause mortality in HIV-infected persons over an average of 6 years of follow-up. These data highlight the importance of lung dysfunction in HIV-infected persons and should be confirmed in larger cohorts and with extended follow-up periods. Clinical trial registered with www.clinicaltrials.gov (NCT00869544, NCT01326572).

Abnormal Lung Function in HIV-infected Adults: An Under-recognized Risk Factor for Early Mortality

“…In summary, Gingo and colleagues have newly demonstrated the increased risk for mortality among HIV-infected persons with airflow obstruction on spirometry as well as impaired DL CO (8). Their findings align with our understanding that HIV is an independent risk factor for worse pulmonary outcomes, ranging from increased respiratory symptoms (20) to increased incident chronic lung disease (7) and to worse morbidity and mortality from chronic lung disease (3).…”

“…HIV infection has been shown to be an independent risk factor for reduced DL CO , with markers of worsening HIV severity correlating with greater reductions in DL CO (13). Studies have found this reduction in DL CO among HIV-infected persons to represent early emphysema by chest computerized tomography imaging (14), yet emphysema did not correlate with increased mortality in the study by Gingo and colleagues (8). Reduced DL CO in HIVinfected persons has also been associated with comorbid pulmonary hypertension (15); however, in this study, echocardiographic measures of pulmonary pressures were not elevated and also did not correlate with mortality.…”

“…Third, because chronic lung diseases including COPD are underdiagnosed among persons living with HIV, as demonstrated by Gingo and others (8,18), the true effect of pulmonary dysfunction on morbidity and mortality of HIV-infected persons is likely underestimated. An intriguing finding in the study by Gingo and colleagues was that participants lacking a physician diagnosis of COPD but with airflow obstruction on study pulmonary function tests suffered a statistically significant 2.6-fold increase in the hazard ratio of all-cause mortality as compared with a referent group of those without COPD (8). The reasons for this finding are unclear, but suggest that a greater recognition of disease may be beneficial for patient outcomes.…”

“…In this month's issue of the AnnalsATS, determined the association between pulmonary function and all-cause mortality among HIV-infected adults by analyzing data from participants recruited from three studies into the Pittsburgh HIV lung cohort: the Pittsburgh AIDS Center for Treatment, Multicenter AIDS Cohort Study, and Women's Interagency HIV Study (8). As part of enrollment, participants underwent pulmonary function testing and standardized noncontrast computerized tomography imaging, with a subset (n = 228, 58%) also completing echocardiograms.…”

Lung Bronchial Epithelial Cells are HIV Targets for Proviral Genomic Integration

“…These putative reservoirs may contribute significantly to the comorbidities of the organ. Frequency and the early onset of OLDs such as chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD) are significantly higher among PLWH (6)(7)(8)(9). Airway mucus hypersecretion is associated with chronic bronchitis and COPD (10) and we have shown that, even after cART, lungs from HIV-infected humans and SIV-infected macaques contain large amounts of mucus (11).…”