Significant chronic airway abnormalities in never‐smoking HIV‐infected patients

Abstract

Objectives The aim of the study was to describe chronic lung disease in HIV‐infected never‐smokers by looking at clinical, structural and functional abnormalities. Methods This comparative cross‐sectional study included 159 HIV‐infected never‐smoking patients [mean (± standard deviation) age 54.6 ± 9.1 years; 13.2% female; 98.1% with undetectable viral load] and 75 nonmatched never‐smoking controls [mean (± standard deviation) age 52.6 ± 6.9 years; 46.7% female]. We examined calcium scoring computer tomography (CT) scans or chest CT scans, all with a lung‐dedicated algorithm reconstruction, to assess emphysema and airway disease (respiratory bronchiolitis and/or bronchial wall thickening), tested pulmonary function using spirometry, lung volumes and the diffusion lung capacity of carbon monoxide (DLCO), and assessed respiratory symptoms using the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT). Results Twenty‐five (17.2%) of the HIV‐infected patients versus two (2.7%) of the controls had a CAT score > 10. Only 5% of the HIV‐infected patients showed FEV1% < 80%, and 25% had DLCO < 75% of the predicted value. Based on the CT scans, they had increased prevalences, compared with the controls, of airway disease (37% versus 7.9%, respectively) and emphysema (18% versus 4%, respectively), with more severe and more frequent centrilobular disease. After correction for age, sex and clinical factors, HIV infection was significantly associated with CAT > 10 [odds ratio (OR) 7.7], emphysema (OR 4), airway disease (OR 4.5) and DLCO < 75% of predicted (OR 4). Conclusions Although comparisons were limited by the different enrolment methods used for HIV‐infected patients and controls, the results suggest that never‐smoking HIV‐infected patients may present with chronic lung damage characterized by CT evidence of airway disease. A minority of them showed respiratory symptoms, without significant functional abnormalities.

Changes in lung function among treated HIV-positive and HIV-negative individuals: analysis of the prospective AGEhIV cohort study

“…7,19 However, CT imaging studies evaluating never-smokers or adolescents with HIV have shown that both airway disease in general as well as small airway disease specifically were more frequently observed in HIV-positive participants compared with controls. [19][20][21] Importantly, these studies have been crosssectional in design and reflect not only recent and ongoing HIV-related damage, but also historical tissue damage. This historical damage includes insults from previous HIV-associated pulmonary infections, lengthy exposure to HIV viraemia, and the cumulative exposures to inhaled toxic substances, such as those from smoking.…”

Independent Associations of Tumor Necrosis Factor-Alpha and Interleukin-1 Beta With Radiographic Emphysema in People Living With HIV

“…In this context, it is noteworthy that emphysema originates around the small airways and that never-smoking PLWH have been found to have small airway dysfunction (32). Moreover, a recent study that included 159 never-smoking PLWH on cART and 75 neversmoking uninfected controls, found a 4-fold increased risk of CT signs of emphysema in PLWH compared to uninfected controls (7). Taken together, these findings suggest that HIV itself, possibly through upregulation of IL-1b dependent inflammatory pathways, could cause destruction of lung parenchyma compatible with emphysematous changes.…”

“…During the current combination antiretroviral therapy (cART) era, comorbidities such as chronic pulmonary diseases are more prevalent in people living with HIV (PLWH) than in the background population (1)(2)(3). Emphysema, characterized by enlargement of terminal air sacs and destruction of alveolar walls, has been suggested to occur more frequently and at younger age in PLWH than in uninfected controls (4)(5)(6)(7). We previously studied radiographic emphysema in PLWH, and although we did not find HIV to be independently associated with emphysema, we found respiratory symptoms to be more prevalent in PLWH with emphysema compared to controls, suggesting a greater clinical impact of emphysema in this population (8).…”

Prevalence of emphysema in people living with human immunodeficiency virus in the current combined antiretroviral therapy era: A systematic review

“…Four of the studies were from an outpatient clinic in Italy, the Modena HIV metabolic clinic (21)(22)(23)(24). The enrolled participants had >18 months of cART exposure (cART coverage 100%) and were >18 years old.…”