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Wang RJ, Nouraie M, Kunisaki KM, Huang L, Tien PC, Anastos K, Bhandari N, Bhatt SP, Bolivar H, Cribbs SK, Foronjy R, Gange SJ, Lazarous D, Morris A, Drummond MB. Lung Function in Women With and Without Human Immunodeficiency Virus. Clin Infect Dis 2023; 76:e727-e735. [PMID: 35604821 PMCID: PMC9907549 DOI: 10.1093/cid/ciac391] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/07/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prior studies have found that human immunodeficiency virus (HIV) infection is associated with impaired lung function and increased risk of chronic lung disease, but few have included large numbers of women. In this study, we investigate whether HIV infection is associated with differences in lung function in women. METHODS This was a cross-sectional analysis of participants in the Women's Interagency HIV Study, a racially and ethnically diverse multicenter cohort of women with and without HIV. In 2018-2019, participants at 9 clinical sites were invited to perform spirometry. Single-breath diffusing capacity for carbon monoxide (DLCO) was also measured at selected sites. The primary outcomes were the post-bronchodilator forced expiratory volume in 1 second (FEV1) and DLCO. Multivariable regression modeling was used to analyze the association of HIV infection and lung function outcomes after adjustment for confounding exposures. RESULTS FEV1 measurements from 1489 women (1062 with HIV, 427 without HIV) and DLCO measurements from 671 women (463 with HIV, 208 without HIV) met standards for quality and reproducibility. There was no significant difference in FEV1 between women with and without HIV. Women with HIV had lower DLCO measurements (adjusted difference, -0.73 mL/min/mm Hg; 95% confidence interval, -1.33 to -.14). Among women with HIV, lower nadir CD4 + cell counts and hepatitis C virus infection were associated with lower DLCO measurements. CONCLUSIONS HIV was associated with impaired respiratory gas exchange in women. Among women with HIV, lower nadir CD4 + cell counts and hepatitis C infection were associated with decreased respiratory gas exchange.
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Affiliation(s)
- Richard J Wang
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Mehdi Nouraie
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ken M Kunisaki
- Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laurence Huang
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Phyllis C Tien
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
- Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
| | - Neha Bhandari
- Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - Surya P Bhatt
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hector Bolivar
- Department of Medicine, University of Miami, Miami, Florida, USA
| | - Sushma K Cribbs
- Department of Medicine, Atlanta Veterans Affairs Health Care System, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert Foronjy
- Department of Medicine, SUNY Downstate Health Sciences University, New York, New York, USA
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deepa Lazarous
- Department of Medicine, Georgetown University, Washington, D.C., USA
| | - Alison Morris
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - M Bradley Drummond
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Raju S, Gearhart AS, Drummond MB, Brown N, Ramamurthi HC, Kirk GD, Brown RH, McCormack MC. Human Immunodeficiency Virus-associated Chronic Obstructive Pulmonary Disease Is Characterized by Increased Small Airways Dysfunction on Computed Tomography Imaging. Ann Am Thorac Soc 2023; 20:335-338. [PMID: 36240211 PMCID: PMC9989864 DOI: 10.1513/annalsats.202203-203rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Sarath Raju
- Johns Hopkins School of MedicineBaltimore, Maryland
| | | | | | - Nicole Brown
- Johns Hopkins University Applied Physics LaboratoryLaurel, Maryland
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3
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Raju S, Astemborski J, Drummond MB, Ramamurthi HC, Sun J, Brown RH, Kirk GD, McCormack MC. Brief Report: HIV Is Associated With Impaired Pulmonary Diffusing Capacity Independent of Emphysema. J Acquir Immune Defic Syndr 2022; 89:64-68. [PMID: 34560768 PMCID: PMC8647697 DOI: 10.1097/qai.0000000000002818] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV is associated with accelerated decline in lung function and increased risk for chronic obstructive pulmonary disease (COPD). Recently, there has been growing attention toward the impairment in the diffusing capacity of the lungs for carbon monoxide (DLCO), a marker of pulmonary gas exchange, observed among persons living with HIV. Although increased emphysema can contribute to the DLCO impairment observed, other factors may drive this association. METHODS Using cross-sectional data from the Study of HIV in the Etiology of Lung Disease, we studied the association between HIV and DLCO independent of emphysema. We also analyzed the joint influence of HIV and COPD on DLCO impairment. An analysis was conducted among 339 participants (229 with HIV) with lung function and chest CT imaging data. Multivariable regression models were generated with percent predicted DLCO and odds of DLCO impairment as outcomes. RESULTS After adjusting for confounders, including emphysema severity, HIV was associated with lower DLCO (β -4.02%; P = 0.020) and higher odds of DLCO impairment (odds ratio 1.93; P = 0.017). Even among those without COPD, HIV was independently associated with lower DLCO (β -3.89%; P = 0.049). Compared with HIV-uninfected participants without COPD, those with both HIV and COPD experienced the greatest impairment in DLCO (β -14.81; P < 0.001). CONCLUSIONS HIV is associated with impaired pulmonary gas exchange independent of emphysema severity. Our data also suggest a potentially additive influence between HIV and COPD on DLCO impairment. Further studies should investigate the other factors, including pulmonary vascular disease, which may contribute to DLCO impairment among persons living with HIV.
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Affiliation(s)
- Sarath Raju
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; and
| | - Michael Bradley Drummond
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Hema C. Ramamurthi
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; and
| | - Jing Sun
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; and
| | - Robert H. Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; and
| | - Gregory D. Kirk
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; and
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4
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Verboeket SO, Boyd A, Wit FW, Verheij E, Schim van der Loeff MF, Kootstra N, van der Valk M, van Steenwijk RP, Drummond MB, Kirk GD, Reiss P. Changes in lung function among treated HIV-positive and HIV-negative individuals: analysis of the prospective AGEhIV cohort study. THE LANCET. HEALTHY LONGEVITY 2021; 2:e202-e211. [DOI: 10.1016/s2666-7568(21)00033-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 12/25/2022] Open
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5
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Ronit A, Benfield T, Lundgren J, Vestbo J, Afzal S, Nordestgaard BG, Kühl JT, Kofoed KF, Nielsen SD, Kristensen T. Interstitial Lung Abnormalities in People With HIV Infection and Uninfected Controls. J Infect Dis 2021; 221:1973-1977. [PMID: 32002544 DOI: 10.1093/infdis/jiaa047] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/27/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chest computed tomography (CT) findings in well-treated people with HIV infection (PWH) remain poorly characterized. METHODS Cross-sectional analysis examining interstitial chest CT findings in PWH (n = 754) and uninfected controls (n = 470). RESULTS HIV infection was independently associated with 1.82 (95% CI, 1.18-2.88) and 5.15 (95% CI, 1.72-22.2) higher adjusted odds of any interstitial lung abnormality and findings suspicious for interstitial lung disease, respectively. CONCLUSIONS HIV infection was independently associated with interstitial lung abnormalities and findings suspicious for interstitial lung disease. Whether these abnormalities develop into more recognizable disease states over time is unknown but warrants further investigation.
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Affiliation(s)
- Andreas Ronit
- Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases 144, Amager Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases 144, Amager Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jens Lundgren
- Copenhagen HIV Program, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Shoaib Afzal
- Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Tobias Kühl
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Kristensen
- Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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6
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Quantitative CT analysis for bronchiolitis obliterans in perinatally HIV-infected adolescents-comparison with controls and lung function data. Eur Radiol 2020; 30:4358-4368. [PMID: 32172382 DOI: 10.1007/s00330-020-06789-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/15/2020] [Accepted: 03/03/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare quantitative chest CT parameters in perinatally HIV-infected adolescents with and without bronchiolitis obliterans compared with HIV-uninfected controls and their association with lung function measurements. MATERIALS AND METHODS Seventy-eight (41 girls) HIV-infected adolescents with a mean age of 13.8 ± 1.65 years and abnormal pulmonary function tests in the prospective Cape Town Adolescent Antiretroviral Cohort underwent contrast-enhanced chest CT on inspiration and expiration. Sixteen age-, sex-, and height-matched non-infected controls were identified retrospectively. Fifty-one HIV-infected adolescents (28 girls) displayed mosaic attenuation on expiration suggesting bronchiolitis obliterans. Pulmonary function tests were collected. The following parameters were obtained: low- and high-attenuation areas, mean lung density, kurtosis, skewness, ventilation heterogeneity, lung mass, and volume. RESULTS HIV-infected adolescents showed a significantly higher mean lung density, ventilation heterogeneity, mass, and high- and low-attenuation areas compared with non-infected individuals. Kurtosis and skewness were significantly lower as well. HIV-infected adolescents with bronchiolitis obliterans had a significantly lower kurtosis and skewness compared with those without bronchiolitis obliterans. Lung mass and volume showed the strongest correlations with forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and alveolar volume. Low-attenuation areas below - 950 HU and ventilation heterogeneity showed the strongest correlation with FEV1/FVC (range, - 0.51 to - 0.34) and forced expiratory flow between 25 and 75% of FVC (range, - 0.50 to - 0.35). CONCLUSION Quantitative chest CT on inspiration is a feasible technique to differentiate perinatally HIV-infected adolescents with and without bronchiolitis obliterans. Quantitative CT parameters correlate with spirometric measurements of small-airway disease. KEY POINTS • Perinatally HIV-infected adolescents showed a more heterogeneous attenuation of the lung parenchyma with a higher percentage of low- and high-attenuation areas compared with non-infected patients. • Kurtosis and skewness are able to differentiate between HIV-infected adolescents with and without bronchiolitis obliterans using an inspiratory chest CT. • Quantitative CT parameters of the chest correlate significantly with pulmonary function test. Low-attenuation areas and ventilation heterogeneity are particularly associated with spirometric parameters related to airway obstruction.
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7
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Inflammatory mediators and lung abnormalities in HIV: A systematic review. PLoS One 2019; 14:e0226347. [PMID: 31830103 PMCID: PMC6907827 DOI: 10.1371/journal.pone.0226347] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022] Open
Abstract
HIV and pneumonia infections have both been shown to negatively impact lung function. However, evidence of the role of inflammation on lung dysfunction in HIV and pneumonia co-infected individuals remains limited. We aimed to systematically review the association of inflammatory markers and lung abnormalities in HIV and pneumonia co-infected individuals. This systematic review was registered with the International Prospective Register of Systematic Reviews on August 15, 2017 (registration number CRD42017069254) and used 4 databases (Cochrane Central Register of Controlled Trials, PubMed Central, Clinical Trials.gov and Google Scholar). All clinical trial, observational, and comparative studies targeting adult (> 18 years old) populations with HIV, pneumonia, or both, that report on immune response (cytokine, chemokine, or biomarker), and lung abnormality as an outcome were eligible. Data selection, risk of bias and extraction were performed independently by 2 blinded reviewers. Due to heterogeneity among the articles, a qualitative synthesis was performed. Our search strategy identified 4454 articles of which, 7 met our inclusion criteria. All of the studies investigated the ability of circulating biomarkers to predict lung damage in HIV. None of the articles included patients with both HIV and pneumonia, nor pneumonia alone. Markers of inflammation (IL-6, TNF-α, CRP), innate defense (cathelicidin), monocyte and macrophage activation (sCD14, sCD163 and, IL-2sRα), endothelial dysfunction (ET-1) and general immune health (CD4/CD8 ratio) were associated with lung abnormalities in HIV. This review highlights the lack of available information regarding the impact of inflammatory mediators on lung function in HIV and pneumonia populations, therefore opportunities to prevent lung damage with available anti-inflammatory treatment or to investigate new ones still remain.
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8
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Verboeket SO, Wit FW, Kirk GD, Drummond MB, van Steenwijk RP, van Zoest RA, Nellen JF, Schim van der Loeff MF, Reiss P, Reiss P, Wit FWNM, van der Valk M, Schouten J, Kooij KW, van Zoest RA, Verheij E, Verboeket SO, Elsenga BC, Prins M, van der Loeff MFS, del Grande L, Olthof V, Dijkstra M, Zaheri S, Hillebregt MMJ, Ruijs YMC, Benschop DP, el Berkaoui A, Kootstra NA, Harskamp-Holwerda AM, Maurer I, Mangas Ruiz MM, Girigorie AF, Boeser-Nunnink B, Zikkenheiner W, Janssen FR, Geerlings SE, Goorhuis A, Hovius JWR, Nellen FJB, van der Poll T, Prins JM, Reiss P, van der Valk M, Wiersinga WJ, van Vugt M, de Bree G, van Eden J, van Hes AMH, Pijnappel FJJ, Weijsenfeld A, Smalhout S, van Duinen M, Hazenberg A, Postema PG, Bisschop PHLT, Serlie MJM, Lips P, Dekker E, van der Velde N, Willemsen JMR, Vogt L, Schouten J, Portegies P, Schmand BA, Geurtsen GJ, Verbraak FD, Demirkaya N, Visser I, Schadé A, Nieuwkerk PT, Langebeek N, van Steenwijk RP, Dijkers E, Majoie CBLM, Caan MWA, van Lunsen HW, Nievaard MAF, van den Born BJH, Stroes ESG, Mulder WMC, van Oorspronk S. Reduced Forced Vital Capacity Among Human Immunodeficiency Virus-Infected Middle-Aged Individuals. J Infect Dis 2018; 219:1274-1284. [DOI: 10.1093/infdis/jiy653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/08/2018] [Indexed: 02/01/2023] Open
Affiliation(s)
- Sebastiaan O Verboeket
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Ferdinand W Wit
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Greg D Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - M Bradley Drummond
- Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill
| | | | - Rosan A van Zoest
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Jeannine F Nellen
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maarten F Schim van der Loeff
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, The Netherlands
| | - Peter Reiss
- Amsterdam UMC, University of Amsterdam, Departments of Global Health and Internal Medicine, Amsterdam Infection and Immunity Institute and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, The Netherlands
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Guo L, Zhang L, Zhao J. CT scan and magnetic resonance diffusion-weighted imaging in the diagnosis and treatment of esophageal cancer. Oncol Lett 2018; 16:7117-7122. [PMID: 30546446 PMCID: PMC6256330 DOI: 10.3892/ol.2018.9532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 09/06/2018] [Indexed: 12/11/2022] Open
Abstract
Value of computed tomography (CT) scan and diffusion-weighted imaging (DWI) in the diagnosis and treatment of esophageal cancer was investigated. Seventy-eight patients with esophageal cancer treated in Jinan Central Hospital (Jinan, China) from January 2013 to June 2014 were selected. All patients underwent CT scan and DWI examination, and their clinical history data were analyzed. DWI was conducted. The short-term curative effect and the 3-year survival rate of patients in the high apparent diffusion coefficient (ADC) value group and the low ADC value group were compared; ADC values in the complete remission (CR) group and the partial remission (PR) group were compared. The difference in value between the length of esophageal lesions and the length of pathological specimens measured by CT scan was significantly different from that detected via DWI examination with b=600, 800 and 1,000 sec/mm2, respectively (P<0.05). The diagnostic rate of esophageal cancer via CT scan was significantly lower than that via DWI examination (P<0.05). After radiotherapy, the clinical control rate in the high ADC value group was significantly higher than that in the low ADC value group, and the 3-year survival rate in the former was significantly higher than that in the latter (P<0.05). In the 2nd week during radiotherapy and at the end of radiotherapy, the ADC values in the CR group were significantly higher than those in the PR group (P<0.05). In the 2nd week during radiotherapy and at the end of radiotherapy, ADC values were used to predict the CR rate of radiotherapy for esophageal cancer, and the areas under the receiver operating characteristic (ROC) curve were 0.776 and 0.935, respectively. Compared with CT scan, DWI has higher diagnostic rate and higher sensitivity. The length of esophageal tumor measured by DWI is close to that of pathological entity, which can guide the delineation of the target area of esophageal cancer.
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Affiliation(s)
- Lei Guo
- Department of MRI, Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
| | - Liulong Zhang
- Department of Radiology, Dongying People's Hospital, Dongying, Shandong 257091, P.R. China
| | - Jianshe Zhao
- Department of Radiology, Jinan Children's Hospital, Jinan, Shandong 250022, P.R. China
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Ronit A, Kristensen T, Hoseth VS, Abou-Kassem D, Kühl JT, Benfield T, Gerstoft J, Afzal S, Nordestgaard B, Lundgren JD, Vestbo J, Kofoed K, Nielsen SD. Computed tomography quantification of emphysema in people living with HIV and uninfected controls. Eur Respir J 2018; 52:13993003.00296-2018. [DOI: 10.1183/13993003.00296-2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/22/2018] [Indexed: 12/14/2022]
Abstract
People living with HIV (PLWH) may be more susceptible to the development of emphysema than uninfected individuals. We assessed prevalence and risk factors for emphysema in PLWH and uninfected controls. Spirometry and chest computed tomography scans were obtained in PLWH from the Copenhagen Comorbidity in HIV Infection (COCOMO) study and in uninfected controls from the Copenhagen General Population Study (CGPS) who were >40 years. Emphysema was quantified using a low attenuation area < −950 Hounsfield units (%LAA-950) and the 15th percentile density index (PD15) and assessed by semi-quantitative visual scales. Of 742 PLWH, 21.2% and 4.7% had emphysema according to the %LAA-950 threshold with cut-offs at 5% and 10%, respectively. Of 470 uninfected controls, these numbers were 24.3% (p=0.23) and 4.0% (p=0.68). HIV was not associated with emphysema (adjusted OR 1.25, 95% CI 0.68–2.36 for %LAA-950 >10%) by PD15 or by visually assessed emphysema. We found no interaction between HIV and cumulative smoking. Breathlessness and sputum production were more common in PLWH with emphysema, and emphysema seemed to be more prevalent in PLWH with airflow limitation. HIV was therefore not independently associated with emphysema, but the clinical impact of emphysema was greater in PLWH than in uninfected controls.
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