Reduced Lung Function Associated With Mortality in HIV
Individuals without a diagnosis of COPD but a post-bronchodilator FEV1/FVC<0.7 had a greater all-cause mortality risk.
According to the results of a recent study published in the Annals of the American Thoracic Society, airflow obstruction and impaired diffusing capacity in people living with HIV were associated with an increased risk for all-cause mortality during approximately 6-year follow-up.
Researchers evaluated pulmonary function in 396 participants with HIV infection. Participants underwent prebronchodilator and postbronchodilator spirometry and single-breath diffusion capacity for carbon monoxide (DLCO). To evaluate for quantitative emphysema, participants underwent computed tomography (CT) of the chest and echocardiogram was used to estimate left ventricular systolic and diastolic function and tricuspid regurgitant velocity. The association of decreased lung function with all-cause mortality during follow-up (median 69 months) was analyzed after adjustment for covariates.
Among the 396 participants with HIV, 32 died during the follow-up period (8%).
Postbronchodilator forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio of <0.7 was associated with increased risk for all-cause mortality during follow-up (hazard ratio [HR] 2.47; 95% CI, 1.10-5.58). Similarly, DLCO of <60% was associated with increased risk for mortality (HR 2.28; 95% CI, 1.08-4.82).
No CT or echocardiogram measures were associated with mortality in multivariable analysis, although greater wall thickness of medium-sized airways was associated with mortality in univariate analysis (HR for wall area percent 1.08; 95% CI, 1.00-1.18; P =.051).
Other factors associated with a higher risk for mortality included hepatitis C infection (HR 2.68; 95% CI, 1.22-5.89) and baseline plasma HIV RNA level (HR per ln RNA copies/mL 1.50; 95% CI, 1.22-1.86).
According to the investigators, “this study is the first to demonstrate that abnormal or impaired lung function is independently associated with increased all-cause mortality in HIV-infected persons.” They concluded that the results are “particularly important as HIV infection is an independent risk factor for a greater degree of airflow obstruction and impaired diffusing capacity and diagnosis of several pulmonary diseases, and HIV-infected individuals are diagnosed with lung disease at an earlier age.”
Gingo MR, Nouraie M, Kessinger CJ, et al. Decreased lung function and all-cause mortality in HIV-infected individuals. Ann Am Thorac Soc. 2018;15(2):192-199.