Pulmonary restriction predicts long-term pulmonary impairment in people with HIV and tuberculosis

Abstract

Background While tuberculosis is considered a risk factor for chronic obstructive pulmonary disease, a restrictive pattern of pulmonary impairment may actually be more common among tuberculosis survivors. We aimed to determine the nature of pulmonary impairment before and after treatment among people with HIV and tuberculosis and identify risk factors for long-term impairment. Methods In this prospective cohort study conducted in South Africa, we enrolled adults newly diagnosed with HIV and tuberculosis who were initiating antiretroviral therapy and tuberculosis treatment. We measured lung function and symptoms at baseline, 6, and 12 months. We compared participants with and without pulmonary impairment and constructed logistic regression models to identify characteristics associated with pulmonary impairment. Results Among 134 participants with a median CD4 count of 110 cells/μl, 112 (83%) completed baseline spirometry at which time 32 (29%) had restriction, 13 (12%) had obstruction, and 9 (7%) had a mixed pattern. Lung function was dynamic over time and 30 (33%) participants had impaired lung function at 12 months. Baseline restriction was associated with greater symptoms and with long-term pulmonary impairment (adjusted odds ratio 5.44, 95% confidence interval 1.16–25.45), while baseline obstruction was not (adjusted odds ratio 1.95, 95% confidence interval 0.28–13.78). Conclusions In this cohort of people with HIV and tuberculosis, restriction was the most common, symptomatic, and persistent pattern of pulmonary impairment. These data can help to raise awareness among clinicians about the heterogeneity of post-tuberculosis pulmonary impairment, and highlight the need for further research into mediators of lung injury in this vulnerable population.

Clinical and Immunological Markers of Pulmonary Impairment Among People With HIV in India

“…Furthermore, the majority of the prior studies have focused on airflow obstruction and COPD. There is growing recognition of restrictive lung diseases and PRISm, that is, low FEV1 without overt airflow obstruction, as important contributors to the burden of CLD in high-risk populations [ 29–31 ]. Given the adverse impact of RSP and PRISm on all-cause mortality and quality of life [ 32–35 ], understanding their predictors is key to understanding long-term health outcomes in vulnerable groups like PWH.…”

Lung function and collagen 1a levels are associated with changes in 6 min walk test distance during treatment of TB among HIV-infected adults: a prospective cohort study

“…affecting or affected by anti-TB treatment or ART were excluded from the LIFT-IRIS study. The baseline visit occurred prior to ART initiation, and patients subsequently had follow-up visits up to 48 weeks after ART initiation [2]. Six-minute walk test distance, lung function, and symptom scores on the chronic obstructive pulmonary disease (COPD) assessment test (CAT) were evaluated at the baseline and at weeks 4, 12, and 24, and biomarkers were measured at baseline, week 4, and week 12, during the time of greatest TB-associated inflammation.…”

“…Keywords Tuberculosis, HIV/TB, Six-minute walk test, Inflammatory biomarkers, Post-treatment Background Tuberculosis (TB) remains a major cause of morbidity and mortality worldwide, causing 10 million cases and 1 million deaths globally in 2021 [1]. While a majority of individuals with TB complete treatment, approximately half of TB survivors have objective evidence of impaired pulmonary function after cure [2][3][4], and a history of TB is associated with reduced long-term survival [3,5,6]. When health losses due to TB are quantified as disability-adjusted life-years (DALYs), 47% of the total burden estimate is attributed to post-TB sequelae [5,6].…”

“…Numerous studies evaluating post-TB sequelae have focused on pulmonary function testing [2,3,6,9,10]. However, TB exerts a negative impact on health that is not entirely captured by assessments of lung function [11][12][13].…”

World AIDS Day: 40 years of an evolving pulmonary landscape

“…(13) Additionally, CLD is increasingly recognized in adolescents who were perinatally infected with HIV(3) and in survivors of tuberculosis as post-tuberculosis related lung disease. (4) In this evolving landscape, future work requires a deeper understanding of how to prevent and treat these CLD in PWH.…”