Effect of smoking on lung function, respiratory symptoms and respiratory diseases amongst HIV-positive subjects: a cross-sectional study

Abstract

BackgroundSmoking prevalence in human immunodeficiency virus (HIV) positive subjects is about three times of that in the general population. However, whether the extremely high smoking prevalence in HIV-positive subjects affects their lung function is unclear, particularly whether smoking decreases lung function more in HIV-positive subjects, compared to the general population. We conducted this study to determine the association between smoking and lung function, respiratory symptoms and diseases amongst HIV-positive subjects.ResultsOf 120 enrolled HIV-positive subjects, 119 had an acceptable spirogram. Ninety-four (79%) subjects were men, and 96 (81%) were white. Mean (standard deviation [SD]) age was 43.4 (8.4) years. Mean (SD) of forced expiratory volume in one second (FEV1) percent of age, gender, race and height predicted value (%FEV1) was 93.1% (15.7%). Seventy-five (63%) subjects had smoked 24.0 (18.0) pack-years. For every ten pack-years of smoking increment, %FEV1 decreased by 2.1% (95% confidence interval [CI]: -3.6%, -0.6%), after controlling for gender, race and restrictive lung function (R2 = 0.210). The loss of %FEV1 in our subjects was comparable to the general population. Compared to non-smokers, current smokers had higher odds of cough, sputum or breathlessness, after adjusting for highly active anti-retroviral therapy (HAART) use, odds ratio OR = 4.9 (95% CI: 2.0, 11.8). However respiratory symptom presence was similar between non-smokers and former smokers, OR = 1.0 (95% CI: 0.3, 2.8). All four cases of COPD (chronic obstructive pulmonary disease) had smoked. Four of ten cases of restrictive lung disease had smoked (p = 0.170), and three of five asthmatic subjects had smoked (p = 1.000).ConclusionsCumulative cigarette consumption was associated with worse lung function; however the loss of %FEV1 did not accelerate in HIV-positive population compared to the general population. Current smokers had higher odds of respiratory symptoms than non-smokers, while former smokers had the same odds of respiratory symptoms as non-smokers. Cigarette consumption was likely associated with more COPD cases in HIV-positive population; however more participants and longer follow up would be needed to estimate the effect of smoking on COPD development. Effective smoking cessation strategies are required for HIV-positive subjects.

Prevalence and determinants of chronic obstructive pulmonary disease in HIV infected patients in an African country with low level of tobacco smoking

“…Moreover, several studies on the association of COPD and HIV did not take into consideration pulmonary tuberculosis. Instead, most of these studies found pneumonia to be an independent factor associated with COPD [4,6,7]. We found no relationship between history of pneumonia and COPD.…”

“…Failure in some previous studies to demonstrate any significant effect of past pulmonary tuberculosis on the occurrence of COPD among HIV subjects was probably due to the lack of statistical power. For instance, in the study conducted by Crothers and al only 8 (7%) patients out of 104 HIV-positive patients had a history of tuberculosis [5] while only 5 (4%) out of 119 HIV patients had tuberculosis in the study by Cui et al [4]. Moreover, several studies on the association of COPD and HIV did not take into consideration pulmonary tuberculosis.…”

HIV and Chronic Obstructive Pulmonary Disease: Is It Worse and Why?

“…The association of ART and airway obstruction persisted even after adjustment for other risk factors, such as age and smoking history. Another study of 119 HIV-infected participants also performed spirometry and found that 3.4% had airway obstruction (14). Lung function was worse in smokers, and over half of the participants reported respiratory symptoms.…”

“…There have been three recent prospective studies that examined respiratory symptoms and measured pulmonary function in the era of combination ART (13)(14)(15). The first study performed spirometry in 234 HIV-infected outpatients without a history of acute respiratory disease or asthma (13).…”

Infections in “Noninfectious” Lung Diseases

“…In the Veterans Aging Cohort Study, a predominantly smoking older male cohort, asthma diagnosis was similar between individuals with and those without HIV (41). Two recent studies with a broader population of individuals with HIV have found that 11 and 21%, respectively, have an asthma diagnosis by history (doctor-diagnosed asthma) (46,47). These prevalence estimates may be greater than the estimated prevalence of approximately 7.6% in the general population (48).…”