Permanent Declines in Pulmonary Function Following Pneumonia in Human Immunodeficiency Virus-Infected Persons

Abstract

Human immunodeficiency virus (HIV)-associated respiratory infections, most notably Pneumocystis carinii pneumonia (PCP), but also bacterial pneumonia (BP), result in reductions in lung function that have been studied mainly during the course of acute infection. Whether HIV-associated pneumonias also cause permanent changes in pulmonary function is unknown. In this study we investigated the long-term effects of PCP and BP on pulmonary function in a cohort of HIV-infected persons. One thousand, one hundred forty-nine HIV-infected persons were followed in a prospective, observational cohort study at six centers in the United States. Study participants had pulmonary function testing performed at regular preset intervals. PCP and BP diagnoses were verified with defined criteria. Longitudinal multivariate analysis was used to model pulmonary function in terms of demographic data and occurrence of PCP or BP. We found that PCP or BP was associated with permanent decreases in FEV(1), FVC, FEV(1)/FVC, and the diffusing capacity of carbon monoxide. Neither infection resulted in statistically significant changes in TLC. We conclude that PCP and BP result in expiratory airflow reductions that persist after the acute infection resolves. The clinical implications of these changes are unknown, but they may contribute to prolonged respiratory complaints in HIV-infected patients who have had pneumonia.

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

“…DL CO , FEV 1 , and peak flow decrease during acute PCP and for at least 3 months after infection (7,21). These changes may be permanent because PCP leads to accelerated declines in FEV 1 , FEV 1 /FVC, and DL CO beyond that expected from age and smoking history (22). We have recently shown that Pccolonized HIV-infected outpatients have worse airway obstruction than Pc-negative HIV-infected persons, independent of smoking history (23).…”

HIV-Associated Bacterial Pneumonia

“…Importantly, both bacterial pneumonia and PCP have been found to be associated with a decline in lung function (as measured by FEV 1 , FVC, FEV 1 /FVC ratio and diffusing capacity of carbon monoxide) that persists following infection [81]. This highlights the importance of the prevention of opportunistic infections in HIV-infected persons.…”

Pulmonary infections in HIV-infected patients: an update in the 21st century

“…These numbers give an idea of the magnitude of the problem of pulmonary infections in HIV patients. Moreover, it has been suggested that Pneumocystis pneumonia (PCP), tuberculosis (TB) and bacterial pneumonia are associated with a significantly worse subsequent HIV disease course, even a permanent decline in pulmonary function [16][17][18][19], although not all studies agree with these findings [20].…”