The Determinants of Poor Respiratory Health Status in Adults Living with Human Immunodeficiency Virus Infection

Abstract

The increased longevity afforded by combination antiretroviral therapy in developed countries has led to an increased concern regarding senescence-related diseases in patients with human immunodeficiency virus (HIV) infection. Previous epidemiologic analyses have demonstrated an increased risk of chronic obstructive pulmonary disease, as well as a significant burden of respiratory symptoms in HIV-infected patients. We performed the St. George's Respiratory Questionnaire (SGRQ) in 199 HIV-positive men, and determined the predominant factors contributing to poor respiratory-related health status. In univariate analyses, worse SGRQ scores were associated with respiratory-related variables such as greater smoking pack-year history (p=0.028), lower forced expiratory volume in 1 second (FEV1) (p<0.001), and worse emphysema severity as quantified by computed tomographic imaging (p=0.017). In addition, HIV-specific variables, such as a history of plasma viral load >100,000 copies/mL (p=0.043), lower nadir CD4 cell count (p=0.040), and current CD4 cell count ≤350 cells/μL (p=0.005), as well as elevated levels of inflammatory markers, specifically plasma interleukin (IL)-6 (p=0.002) and alpha-1 antitrypsin (p=0.005) were also associated with worse SGRQ scores. In a multiple regression model, FEV1, current CD4 count ≤350 cells/μL, and IL-6 levels remained significant contributors to reduced respiratory-related health status. HIV disease activity as measured by HIV-related immunosuppression in conjunction with the triggering of key inflammatory pathways may be important determinants of worse respiratory health status among HIV-infected individuals. Limitations of this analysis include the absence of available echocardiograms, diffusion capacity and lung volume testing, and an all-male cohort due to the demographics of the clinic population.

Respiratory symptoms in people living with HIV and the effect of antiretroviral therapy: a systematic review and meta-analysis

“…This is important, as lung function impairment can correlate poorly with symptoms and functional status 10. We sought, therefore, to provide a comprehensive analysis of existing data regarding respiratory symptoms in people living with HIV with the aim of understanding how this might have changed with ART, and where deficiencies in the current evidence base exist.…”

Screening for Chronic Obstructive Pulmonary Disease (COPD) in an Urban HIV Clinic: A Pilot Study

“…1 For patients infected with HIV, the prevalence of COPD is likely higher and is an increasing cause of poor respiratory health and death in this population. [2][3][4] This increase in COPD is thought to be due to an increased prevalence of smoking in patients with HIV/ AIDS [5][6][7][8][9][10][11][12] in combination with a detrimental amplified inflammatory response in the lungs of those exposed to toxins in cigarette smoke. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Patients with HIV/AIDS also have increased barriers to smoking cessation, which adds to the risk for COPD over time.…”

“…19,24 Studies show that in addition, HIV infected patients with higher HIV viral loads or lower CD4 T-cell counts have more rapid decline in pulmonary function, worse disease, and likely worse diffusing capacity than similar patients without HIV. 2,4,31,32 Whether peak flow is influenced by these factors in a similar manner remains less clear.…”

Respiratory health status is impaired in UK HIV‐positive adults with virologically suppressed HIV infection

“…Two previous reports used the SGRQ to evaluate respiratory health in HIV-positive adults: Hirani et al evaluated 98 consecutive HIV-positive individuals (84% male) attending HIV care services in Philadelphia, USA, and found a mean SGRQ Total score of 7 [22]; in contrast, Leung et al reported a mean SGRQ Total score of 32 in 199 HIV-positive men attending care services in Vancouver, Canada [9]. Our data therefore provide the first estimate of the difference in respiratory health (as experienced by individuals) between HIV-positive adults with optimized access to ART and HIV-negative adults.…”

“…Furthermore, most studies assessing respiratory health in HIV-positive populations have focused on objective measurements of lung function (such as spirometry) rather than the subjective impact of respiratory impairment on health-related quality of life [5,8]. This is an important issue, as respiratory symptoms can correlate poorly with objectively measured lung function [9], yet may have a significant effect on quality of life. There is a need, therefore, to better understand the degree to which PLWH with access to effective ART have worse respiratory health than HIVnegative individuals (with similar risk factors), and the impact of this on their quality of life [10].…”