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People with HIV have impaired respiratory health, even when viral load is undetectable
Michael Carter, 2017-05-23 07:40:00
people have impaired respiratory health, even when they have viral
suppression with antiretroviral therapy (ART), investigators from London report
in HIV Medicine. Respiratory health
was compared between HIV-positive and HIV-negative outpatients. Individuals
with HIV had poorer respiratory health and were more likely to report
breathlessness than HIV-negative participants, findings which remained
unchanged when analysis focused on ART-treated HIV-positive people with an
undetectable viral load.
“To our knowledge,
no other study has used patient-reported outcomes to compare respiratory health
status in HIV-positive and HIV-negative populations,” comment the authors. “Our
results suggest that HIV remains associated with impaired respiratory health
despite virological suppression with ART.”
Thanks to ART,
many HIV-positive people now have a near-normal life expectancy. However,
rates of heart, liver and kidney disease remain elevated. Research involving US
military veterans also found that HIV-positive people had a significantly
higher prevalence of chronic obstructive pulmonary disease (COPD).
the Royal Free Hospital, London, wanted to further understand the relationship
between HIV infection and respiratory health in the modern ART era.
designed a study involving 197 HIV-positive people and 93 HIV-negative
controls attending their hospital’s HIV and sexual health outpatient clinics in
2015. Participants completed a questionnaire focusing on their respiratory health
(St George’s Respiratory Questionnaire – SGRQ) and a separate Medical Research
Council (MRC) questionnaire on breathlessness. Participants also had a spirometry
test to assess lung function.
The median CD4
cell count of the HIV-positive participants was 627 cells/mm3. Most
(94%) reported taking ART, with a median duration of therapy of seven years.
Overall, 89% of people had an undetectable viral load (below 40 copies/ml),
including 93% of individuals taking ART.
There were no
differences in gender, educational attainment, or country of birth between the
HIV-positive and HIV-negative participants. However, people with HIV were
more likely to be white compared to the HIV-negative controls (72%
vs 60%) and the HIV-negative people had a younger median age than the
HIV-positive people (43 vs 50 years).
Both groups had
similar prevalences of co-morbidities such as asthma, COPD, heart disease and
stroke. However, depression was more common in people with HIV (20% vs 14%).
of both groups reported being current (30% vs 33%) or ex- (28% vs 25%)
smokers, although people with HIV smoked more cigarettes per day (15 vs 10, p<0.001). Similar proportions of HIV-positive and HIV-negative participants reported
current recreational drug use (30% vs 20%), though people with HIV were more
likely to report historic drug use (61% vs 48%).
measured by spirometry was within normal limits for most people, but 11% of
HIV-positive people and 9% of HIV-negative individuals had evidence of
There was a higher
prevalence of respiratory health impairment measured by SGRQ (p < 0.001) and
breathlessness among the people with HIV (p = 0.001) compared to HIV-negative
was common in HIV-positive participants, with 47%...reporting this to be
present and of at least moderate severity, compared with 25% of the HIV-negative
participants,” write the authors. “Using the SGRQ respiratory health
questionnaire…we found a 6-point difference in the median total score between
HIV-positive and HIV-negative groups.”
respiratory health was associated with poorer lung function and depression.
Combining the HIV-positive and HIV-negative groups, there were no significant
associations between respiratory health and gender, ethnicity, smoking status
and drug use. An association with higher BMI was of borderline significance.
In an analysis
restricted to HIV-positive individuals, neither current nor nadir CD4 count was
significantly associated with SGRQ score. No significant difference in
respiratory health score was identified according to viral load. However, there
was some evidence that people with longer-standing HIV infection had poorer
SGRQ scores. There was also a relationship between poorer respiratory health
and longer interval between diagnosis with HIV and starting ART.
for potential confounders, HIV infection was independently associated with an
increased SGRQ score (adjusted fold-change, 1.54; 95% CI, 1.14-2.09, p = 0.005)
and higher chances of at least moderate breathlessness (aOR = 2.84; 95% CI,
1.35-6.00, p = 0.006).
remained unchanged when comparing HIV-positive people with an undetectable
viral load with the HIV-negative participants.
risk factors for breathlessness were female gender (p = 0.001) and depression (p
The authors offer
several possible explanations for their findings:
- Lung disease before starting
Cardiovascular disease and
other non-lung-related co-morbidities that cause respiratory symptoms.
Persistent immune dysregulation
despite virologically suppressive ART leading to hardening of the arteries.
that can preserve the respiratory health of people with chronic HIV infection
are needed,” conclude the authors. “However, why HIV infection is associated
with apparent worse respiratory health even in never-smokers remains uncertain
and requires further investigation.”