Pulmonary function tests in HIV-infected patients without AIDS. Pulmonary Complications of HIV Infection Study Group.

Abstract

To determine the prevalence, incidence, and types of lung diseases that occur in association with HIV infection, 1,353 subjects, including HIV-seropositive homosexual men, injection drug users, female sexual partners of HIV-positive men, and HIV-seronegative control subjects from the first two transmission categories were evaluated prospectively in a multicenter study. Patients with AIDS at the time of initial evaluation were excluded. One thousand two-hundred ninety-four subjects who had no AIDS-defining diagnosis within 3 mo of enrollment had measurements of FVC, FEV1 and DLCO at the time of enrollment. As a group, all subjects had mean values of FVC and FEV1 close to 100% predicted. Those with CD4 counts below 200/mm3 had slightly reduced DLCO compared with the others. Subjects with a history of HIV-associated symptoms (thrush, weight loss, herpes zoster) also had a reduced DLCO compared with those without symptoms. Injection drug users had reduced FVC, FEV1 and DLCO compared with homosexual men and female sexual partners of HIV-infected men, with DLCO more substantially reduced. Part of the reduction in DLCO in drug users was attributable to factors other than HIV infection, especially cigarette smoking and race. Using predicted values that take cigarette smoking into account, the prevalence of abnormality in DLCO was higher among injection drug users (33.3%) than among homosexual men (11.2%) and female sexual partners (12.7%). These results show that advanced HIV infection, characterized by CD4 count < 200/mm3 or HIV-associated symptoms, and factors unrelated to HIV infection, including race, cigarette smoking, and injection drug use, are all associated with reductions in DLCO measurements.

Pulmonary Function Abnormalities in HIV-Infected Patients during the Current Antiretroviral Therapy Era

“…Before combination ARV, lung function impairment was worse with more advanced HIV disease, and similar to our study, abnormally low diffusing capacity was the most prominent finding (31,32). The DL CO % predicted in pre-ARV cohorts of HIVinfected outpatients was somewhat higher than in our cohort (78.5-84.8% vs. 72.3%) and was associated with cigarette smoking, IV drug use, CD4 cell count, PCP, and Kaposi sarcoma (7,8,(32)(33)(34). Although we also found an association of diffusing capacity with smoking and IV drug use, we did not find an independent association with CD4 cell count and none of our subjects reported a history of Kaposi sarcoma.…”

“…The only study in the combination ARV era found a lower prevalence of overall symptoms (31.5%), but was performed in a younger cohort with a lesser smoking history (12). Prior studies have also documented a high prevalence of abnormalities in spirometry and diffusion (8,31,32). Before combination ARV, lung function impairment was worse with more advanced HIV disease, and similar to our study, abnormally low diffusing capacity was the most prominent finding (31,32).…”

“…Prior studies have also documented a high prevalence of abnormalities in spirometry and diffusion (8,31,32). Before combination ARV, lung function impairment was worse with more advanced HIV disease, and similar to our study, abnormally low diffusing capacity was the most prominent finding (31,32). The DL CO % predicted in pre-ARV cohorts of HIVinfected outpatients was somewhat higher than in our cohort (78.5-84.8% vs. 72.3%) and was associated with cigarette smoking, IV drug use, CD4 cell count, PCP, and Kaposi sarcoma (7,8,(32)(33)(34).…”

“…Studies of pulmonary function in individuals with HIV infection before potent ARV therapy documented a high prevalence of respiratory abnormalities (8,31,32). A study of respiratory symptoms from the pre-ARV era found a greater prevalence of sputum production (41% vs. 31.7%) and wheezing (approxi- mately 39% vs. 18.6%) compared with our population, but similar prevalence of shortness of breath (41.6% vs. 43.7%) and cough (40% vs. 37.1%).…”

Factors associated with inspiratory muscle weakness in patients with HIV-1

“…Inspiratory muscle dysfunction is related to the severity of HIV infection. 16,20 The present data reveal that 55% of HIVinfected patients presented IMW in a sample of clinically stable patients. This finding is compatible with previous studies.…”