Abstract
BackgroundWhile tuberculosis is considered a risk factor for chronic obstructive pulmonary disease, a restrictive pattern of pulmonary impairment may actually be more common among tuberculosis survivors. We aimed to determine the nature of pulmonary impairment before and after treatment among people with HIV and tuberculosis and identify risk factors for long-term impairment.MethodsIn this prospective cohort study conducted in South Africa, we enrolled adults newly diagnosed with HIV and tuberculosis who were initiating antiretroviral therapy and tuberculosis treatment. We measured lung function and symptoms at baseline, 6, and 12 months. We compared participants with and without pulmonary impairment and constructed logistic regression models to identify characteristics associated with pulmonary impairment.ResultsAmong 134 participants with a median CD4 count of 110 cells/μl, 112 (83%) completed baseline spirometry at which time 32 (29%) had restriction, 13 (12%) had obstruction, and 9 (7%) had a mixed pattern. Lung function was dynamic over time and 30 (33%) participants had impaired lung function at 12 months. Baseline restriction was associated with greater symptoms and with long-term pulmonary impairment (adjusted odds ratio 5.44, 95% confidence interval 1.16–25.45), while baseline obstruction was not (adjusted odds ratio 1.95, 95% confidence interval 0.28–13.78).ConclusionsIn this cohort of people with HIV and tuberculosis, restriction was the most common, symptomatic, and persistent pattern of pulmonary impairment. These data can help to raise awareness among clinicians about the heterogeneity of post-tuberculosis pulmonary impairment, and highlight the need for further research into mediators of lung injury in this vulnerable population.
Highlights
While tuberculosis is considered a risk factor for chronic obstructive pulmonary disease, a restrictive pattern of pulmonary impairment may be more common among tuberculosis survivors
Pulmonary restriction has greater symptoms and radiologic involvement at baseline At baseline, pulmonary symptoms were moderately inversely correlated with both FEV1 (ρ = -0.28, p value 0.004) and forced vital capacity (FVC) (ρ = − 0.28, p value 0.003), such that participants with worse symptoms tended to have a lower FEV1 and FVC (Additional file 1: Figure S1)
PFT pulmonary function test, OR odds ratio, 95% Confidence interval (CI) 95% confidence interval, HbA1c hemoglobin A1c, CATCOPD assessment test, TTP time to positivity, TB tx tuberculosis treatment, ARTantiretroviral therapy, CT computed tomography a Adjusted for age, gender, change in CD4 count from baseline to week 4, time from TB treatment to ART initiation
Summary
While tuberculosis is considered a risk factor for chronic obstructive pulmonary disease, a restrictive pattern of pulmonary impairment may be more common among tuberculosis survivors. We aimed to deter‐ mine the nature of pulmonary impairment before and after treatment among people with HIV and tuberculosis and identify risk factors for long-term impairment. Post-tuberculosis lung impairment has traditionally been viewed as an obstructive phenomenon, similar to chronic obstructive pulmonary disease (COPD), where patients have difficulty exhaling as a result of inflammation and damage to the large airways. Treatment for pulmonary obstruction focuses on relieving airflow limitation with bronchodilators and inhaled corticosteroids. There are limited treatments available for fibrotic pulmonary diseases, none of which have been studied in patients with tuberculosis [13]
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