Effects of smoking and clinical status on lung function in human immunodeficiency virus (HIV)-seropositive subjects

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Lung function was measured at 3-month intervals for up to 1 yr in a group of Caucasian HIV-seropositive subjects. The objective was to document any deterioration in lung function and seek correlations between such deterioration and smoking history and Centers for Disease Control (CDC) status. Ninety-nine subjects were studied at enrolment; 43 were followed-up (mean duration 9 ± 3 months). Ninety-five of the 99 enrolled subjects remained free of HIV-related respiratory disease and were included in the analysis. At enrolment, carbon monoxide diffusing capacity ( T lCO) was significantly lower than predicted in non-smokers, smokers and ex-smokers (88, 77 and 88%, respectively, P<0·001). The T lCO measurements in the smoking group were significantly lower than those of the life-long non-smoking subjects ( P<0·01). Residual volume (RV) was significantly higher than predicted in smokers (111%, P=0·02). During follow-up, all three groups demonstrated significant declines in T lCO (7%, P=0·01; 9%, P=0·005; 13%, P<0·001, respectively), and increases in RV (9%, P=0·03; 13·5%, P=0·02; 22%, P=0·02, respectively). At enrolment, significantly lower than predicted values of T lCO were observed in groups stratified by CDC criteria: in asymptomatic HIV-seropositive subjects (CDC II) 89%, p=0·01; persistent generalized lymphadenopathy (PGL) 84%; AIDS-related complex (ARC) 81%; and in non-pulmonary AIDS (IV C1) 69%, P=0·0001, respectively. Residual volume was significantly higher than predicted in CDC II (114%, P=0·05). During follow-up, T lCO fell in groups PGL and ARC by 7 and 9%, respectively, while RV increased in groups CDC II, PGL and ARC by 17, 15 and 8%, respectively. Only the T lCO decline in PGL showed any linkage to clinical deterioration. This study demonstrates deficits at enrolment, and a continuing decline of T lCO and increase in RV in HIV-seropositive subjects without overt lung disease.