Independent association of subclinical coronary artery disease and emphysema in <scp>HIV</scp>‐infected patients

Besutti, Giulia; Raggi, Paolo; Zona, Stefano; Scaglioni, Riccardo; Santoro, Antonella; Orlando, Gabriella; Ligabue, Guido; Leipsic, Jonathon; Sin, Donald; Man, S. F. Paul; Guaraldi, Giovanni

doi:10.1111/hiv.12289

Cited by 12 publications

(14 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Emphysema has also been associated with extrapulmonary inflammatory diseases, such as non-obstructive coronary artery disease, in HIV. [41] Of note, in this study we found a trend towards higher sCD14, in subjects with emphysema but no significant association, which may challenge the role of monocyte-specific inflammation in emphysema among those with HIV. [4]…”

Section: Discussioncontrasting

confidence: 55%

A Low Peripheral Blood CD4/CD8 Ratio Is Associated with Pulmonary Emphysema in HIV

et al. 2017

View full text Add to dashboard Cite

ObjectivesThe prevalence of emphysema is higher among HIV-infected (HIV+) individuals compared to HIV-uninfected persons. While greater tobacco use contributes, HIV-related effects on immunity likely confer additional risk. Low peripheral blood CD4+ to CD8+ T-lymphocyte (CD4/CD8) ratio may reflect chronic inflammation in HIV and may be a marker of chronic lung disease in this population. Therefore, we sought to determine whether the CD4/CD8 ratio was associated with chronic obstructive pulmonary disease (COPD), particularly the emphysema subtype, in a cohort of HIV+ subjects.MethodsWe performed a cross-sectional analysis of 190 HIV+ subjects enrolled in the Examinations of HIV Associated Lung Emphysema (EXHALE) study. Subjects underwent baseline laboratory assessments, pulmonary function testing and chest computed tomography (CT) analyzed for emphysema severity and distribution. We determined the association between CD4/CD8 ratio and emphysema, and the association between CD4/CD8 ratio and pulmonary function markers of COPD.ResultsMild or greater emphysema (>10% lung involvement) was present in 31% of subjects. Low CD4/CD8 ratio was associated with >10% emphysema in multivariable models, adjusting for risk factors including smoking, current and nadir CD4 count and HIV RNA level. Those with CD4/CD8 ratio <0.4 had 6.3 (1.1–39) times the odds of >10% emphysema compared to those with a ratio >1.0 in fully adjusted models. A low CD4/CD8 ratio was also associated with reduced diffusion capacity (DLCO).ConclusionsA low CD4/CD8 ratio was associated with emphysema and low DLCO in HIV+ subjects, independent of other risk factors and clinical markers of HIV. The CD4/CD8 ratio may be a useful, clinically available, marker for risk of emphysema in HIV+ subjects in the antiretroviral therapy (ART) era.

show abstract

Section: Discussioncontrasting

confidence: 55%

A Low Peripheral Blood CD4/CD8 Ratio Is Associated with Pulmonary Emphysema in HIV

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Only one prior study has examined the relationship between lung disease and CAD, to our knowledge (43). In this study, Agatston CAC scores and visual emphysema scores were assessed using EKG-gated cardiac CT scans.…”

Section: Original Researchmentioning

confidence: 99%

Lung Function, Coronary Artery Disease, and Mortality in HIV

Chandra¹,

Gupta²,

Fitzpatrick³

et al. 2019

Annals ATS

View full text Add to dashboard Cite

Rationale: Impaired lung function is a potent independent predictor of coronary artery disease (CAD) in individuals without human immunodeficiency virus (HIV) infection; however, the relationship between lung function and CAD in HIV remains undefined. Objectives: To examine the relationship between lung function, CAD, mortality, and circulating biomarkers in HIV. Methods: Spirometry, diffusing capacity of the lung for carbon monoxide (DL CO), emphysema, coronary artery calcium, mortality, cause of death, and biomarkers were examined in HIV-infected and uninfected individuals enrolled in a cohort study at the University of Pittsburgh. Results were then validated in the Multicenter AIDS Cohort Study (MACS) cohort. Results: We examined data on 234 participants in the Pittsburgh cohort. The mean 6 standard deviation age was 49.5 6 10.2 years old, 82.1% were male, and 67.5% were ever smokers. Among the 177 of 234 individuals with HIV infection, lower DL CO (not forced expiratory volume in 1 second or emphysema) was independently associated with greater coronary artery calcium (odds ratio, 1.43 per 10% lower DL CO ; 95% confidence interval, 1.14-1.81). HIVinfected individuals with both reduced DL CO and coronary artery calcium had a much higher mortality than those with either low DL CO or coronary calcium alone or with neither condition. Endothelin-1, a circulating biomarker of endothelial dysfunction, was associated with both lower DL CO and greater coronary artery calcium in those with HIV infection. Results were reproducible in 144 individuals enrolled in the MACS cohort; intercellular adhesion molecule 1 was the biomarker of endothelial dysfunction assessed in the MACS cohort. Conclusions: Impaired DL CO and CAD were associated with each other and with higher mortality in individuals with HIV infection.

show abstract

“…We do have concerns that lung disease remains undertreated among PLWH, as previous studies from SHIELD demonstrated that nearly 25% of those with severe COPD were not even aware of their diagnosis of COPD 30 . Previous studies have also suggested that worsened pulmonary disease goes hand and hand with progression of other HIV related comorbidities 31,32 . While we did adjust for the presence of several comorbidities, our analysis was unable to account for severity of disease in a number of important comorbidities, including cardiovascular disease and renal failure.…”

Section: Discussionmentioning

confidence: 99%

Association of Lung Function With HIV-Related Quality of Life and Health Care Utilization in a High-Risk Cohort

Raju¹,

McCormack²,

Drummond

et al. 2020

JAIDS Journal of Acquired Immune Deficiency Syndromes

View full text Add to dashboard Cite

Background: Chronic respiratory disease represents an important comorbidity for persons living with HIV(PLWH). HIV itself is associated with greater impairment in lung function. We aimed to determine the association between declining lung function and both quality of life(QOL) and healthcare utilization for PLWH.Methods: Using longitudinal data from the Study of HIV in the Etiology of Lung Disease (SHIELD) 2009-2017, we studied the association between changes in lung function and both QOL and acute care events(ED visit or hospitalization). The Medical Outcomes Studies-HIV Questionnaire provided QOL domains. Multivariable regression models were performed with generalized estimating equations accounting for 1499 participants, 485 with HIV, contributing 10,825 spirometry visits.Results: Among PLWH, decreased FEV 1 was associated with worse physical health for those with higher viral load(β −1.66, 95%CI −3.11 to −0.39) compared to those with viral suppression(β −0.58, 95%CI −1.06 to −0.162), even in those without airflow obstruction. Lower FEV 1 was also associated with increased odds of both ED(OR 1.21, 95%CI 1.09 to 1.34) and inpatient(OR 1.26, 95%CI 1.12 to 1.42) hospitalizations for PLWH. Lung function was not associated with increased odds of acute care events for HIV-uninfected participants.Conclusions: FEV 1 declines represent an independent predictor of QOL and acute care events among PLWH. Though the generalizability of these results may be limited, due to the high-risk population included, findings suggest that care for PLWH should involve monitoring FEV 1 over time, especially in those with poor virologic control, with emphasis on the development and implementation of interventions to mitigate lung function decline.

show abstract

Independent association of subclinical coronary artery disease and emphysema in HIV‐infected patients

Cited by 12 publications

References 34 publications

A Low Peripheral Blood CD4/CD8 Ratio Is Associated with Pulmonary Emphysema in HIV

A Low Peripheral Blood CD4/CD8 Ratio Is Associated with Pulmonary Emphysema in HIV

Lung Function, Coronary Artery Disease, and Mortality in HIV

Association of Lung Function With HIV-Related Quality of Life and Health Care Utilization in a High-Risk Cohort

Contact Info

Product

Resources

About