Prevalence of and risk factors for pulmonary abnormalities in HIV‐infected patients treated with antiretroviral therapy

Abstract

BackgroundPulmonary abnormalities are often present in patients infected with the human immunodeficiency virus (HIV). ObjectivesThe aim of the study was to determine the prevalence and characteristics of, and risk factors for, pulmonary abnormalities in HIV-positive patients. MethodsA total of 275 HIV-positive patients [mean (± standard deviation) age 48.5 ± 6.6 years] were included in the study, of whom 95.6% had been receiving highly active antiretroviral therapy (HAART) for a mean (± standard deviation) duration of 11.9 ± 5.4 years. The median (interquartile range) CD4 lymphocyte count was 541 (392-813) cells/μL, and 92% of the patients had an undetectable viral load. We determined: (1) spirometry, static lung volumes, lung diffusing capacity, pulmonary gas exchange and exercise tolerance, and (2) the amount of emphysema via a computed tomography (CT) scan. ResultsChronic cough and expectoration (47%) and breathlessness during exercise (33.9%) were commonly reported. Airflow limitation (AL) was present in 17.2%, low pulmonary diffusing capacity in 52.2% and emphysema in 10.5−37.7% of patients, depending on the method used for quantification. Most of these abnormalities had not been diagnosed or treated previously. Smoking exposure and previous tuberculosis were the main risk factors for AL, whereas smoking exposure and several variables related to HIV infection appeared to contribute to the risk of emphysema and low diffusing capacity. ConclusionsDespite HAART, pulmonary structural and functional abnormalities are frequent in HIV-positive patients. They are probably attributable to both environmental (smoking and tuberculosis) and HIV-related factors. Most of these abnormalities remain unnoticed and untreated. Given the relatively young age of these patients, these results anticipate a significant health problem in the next few years as, thanks to the efficacy of HAART, patients survive longer and experience the effects of aging.Keywords: airflow limitation, chronic obstructive pulmonary disease, emphysema, HIV, tuberculosis, smoking IntroductionAIDS remains a challenge for health care systems around the world as a consequence of its health and also its social impact [1,2]. During the early years of the pandemic, Pneumocystis jirovecii (formerly Pneumocystis carinii) pneumonia, tuberculosis, bacterial pneumonia and Kaposi's sarcoma were the major causes of morbidity and mortality [3]. The introduction of highly active antiretroviral therapy (HAART) considerably improved the prognosis and quality of life of HIV-infected patients [4,5]. Previous studies have identified a high prevalence of airflow limitation (AL) and pulmonary emphysema in patients infected with HIV [6][7][8][9][10][11][12][13][14][15]. Yet, lung function assessment has not been included in large multicentre studies aimed at characterizing events not directly related to HIV infection in these patients [16,17]. Lung function testing is also not normally considered part of the routine clinical assessment of these patients, despite the availabili...

Emphysema in HIV Positive Patient: Diagnostic and Therapeutic Conduct

“…Sampériz et al [3] observed the presence of airflow limitation, decreased air diffusion capacity, finding smoking and previous TB infection as the main risk factors, as found in our case.…”

“…In conclusion, an association was suggested between respiratory alterations with advanced age, smoking habit and high viral loads. In turn, it was shown that ARV treatment is an independent predictor of increased airway obstruction [3,4].…”

Risk Factors Associated With Quantitative Evidence of Lung Emphysema and Fibrosis in an HIV-Infected Cohort

“…Our findings are consistent with Samperiz and colleagues who reported no relation between quantitative assessment of emphysema on CT scan and either HIV viral load or CD4 count. 52 However, they reported that the Center for Disease Control HIV category C was a risk factor for quantitative emphysema and a modest emphysema prevalence (10.5%) using a low emphysema cutoff (greater than 1% of voxels with a value less than -950HU). Three recent studies of HIV-infected cohorts 46,48,52 observed that greater than 30% of the subjects had some evidence of emphysema by visual CT image assessment, which is somewhat higher than our findings of 25.1% by quantitative analysis.…”

“…46,48-52 Furthermore, to our knowledge only two studies performed quantitative CT analyses. 27,52 A quantitative approach may be more sensitive to detect correlations between lung abnormalities on radiographic images and biological/physiological measures as well as to detect lung abnormalities at an earlier stage compared to subjective visual image review.…”

Usefulness of Bronchoscopic Probe-Based Confocal Laser Endomicroscopy in the Diagnosis of <b><i>Pneumocystis jirovecii</i></b> Pneumonia

“…Despite the availability of highly active antiretroviral therapy and the widespread use of PJP prophylaxis [20], the latter still is one of the commonest opportunistic infections in HIV+ patients [21,22]. Additionally, the high mortality of patients with PJP requiring mechanical ventilation remains unchanged (50-60%) [23].…”