Abstract
BackgroundStudies have associated HIV with an increased risk of obstructive lung disease (OLD).ObjectivesWe aimed to identify the predictive factors for impaired lung function in an urban, African, HIV-positive population.MethodA cross-sectional study was performed in Johannesburg, South Africa, from July 2016 to November 2017. A questionnaire was administered and pre- and post-bronchodilator spirometry conducted. The predictors investigated included age, sex, antiretroviral treatment (ART) duration, body mass index, history of tuberculosis (TB) or pneumonia, occupational exposure, environmental exposure, smoking and symptoms of OLD (cough, wheeze, mucus and dyspnoea). Impaired lung function was defined as a forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio of < 0.70, or below the 20th percentile of normal.ResultsThe 98 ART-naïve participants (mean age = 34.0, standard deviation [s.d.] = 8.2), 85 participants on first-line ART (mean age = 36.9, s.d. = 6.6) and 189 participants on second-line ART (mean age = 43.5, s.d. = 7.9) were predominantly female (65.6%). Of the participants, 64 (17.2%) had impaired lung function and 308 had normal lung function. Linear regression identified age (β = –0.003, P < 0.01), male sex (β = –0.016, P = 0.03) and history of TB or pneumonia (β = –0.024, P < 0.01) as independent predictors of a lower FEV1/FVC ratio. Following logistic regression, only a history of TB or pneumonia (odds ratio = 2.58, 95% confidence interval = 1.47–4.52) was significantly related to impaired lung function (area under the receiver operating characteristic curve = 0.64).ConclusionOur data show that a history of TB or pneumonia predicts impaired lung function. In order to improve timely access to spirometry, clinicians should be alert to the possibility of impaired lung function in people with a history of TB or pneumonia.
Highlights
Studies have associated HIV with an increased risk of obstructive lung disease (OLD)
In 2018, there were an estimated 37.9 million persons living with HIV (PLWH), of whom approximately 70% resided in sub-Saharan Africa (SSA).[1]
Of the 64 impaired lung function cases, 46 had an forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio below the 20th percentile, which included 13 chronic obstructive pulmonary disease (COPD) cases according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and LLN 5th-percentile cut-offs and 10 cases who met the Global Initiative for Asthma (GINA) criteria for asthma
Summary
Studies have associated HIV with an increased risk of obstructive lung disease (OLD). The life expectancy of PLWH has increased, and HIV is becoming a chronic disease with an increased risk of age-related comorbidities.[2,3,4]. One of the comorbid complications noted among ART-compliant HIV patients is reduced pulmonary function, including obstructive lung disease (OLD), which comprises asthma and chronic obstructive pulmonary disease (COPD).[5,6,7,8] While HIV was found to be independently associated with COPD, the relationship between HIV and asthma remains ambiguous.[5,9,10] The burden of these chronic diseases is high and increasing; a review by Drummond and Kirk indicates an OLD prevalence of 16% – 20% in PLWH.[11] The underlying biological mechanisms are not yet entirely understood. Direct virus-related pulmonary toxicity, persistent systemic inflammation, a modified antioxidant/oxidant balance resulting in oxidative stress, and expedited immune deterioration are among the complex mechanisms that may explain the increased risk of http://www.sajhivmed.org.za
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call