Abstract
BackgroundWith the widespread use of anti-retroviral therapy (ART), individuals infected with human immune deficiency virus (HIV) are increasingly experiencing morbidity and mortality from respiratory disorders. However, the prevalence or the risk factors associated with emphysema and bronchiolitis are largely unknown.MethodsThoracic computed tomography (CT) scans were performed in 1,446 patients infected with HIV who were on ART and who attended a tertiary care metabolic clinic (average age 48 years and 29% females). Detailed history and physical examination including anthropometric measurements were performed. Complete pulmonary function tests were performed in a subset of these patients (n = 364). No subjects were acutely ill with a respiratory condition at the time of CT scanning.FindingsNearly 50% of the subjects had CT evidence for emphysema, bronchiolitis or both with 13% (n = 195) showing bronchiolitis, 19% (n = 274) showing emphysema and 16% (n = 238) revealing both. These phenotypes were synergistically associated with reduced regular physical activity (p for interaction <.0001). The most significant risk factors for both phenotypes were cigarette smoking, intravenous drug use and peripheral leucocytosis. Together, the area-under-the curve statistics was 0.713 (p = 0.0037) for discriminating those with and without these phenotypes. There were no significant changes in lung volumes or flow rates related to these phenotypes, though the carbon monoxide diffusion capacity was reduced for the emphysema phenotype.InterpretationEmphysema and bronchiolitis are extremely common in HIV-infected patients who are treated with ART and can be identified by use of thoracic CT scanning.
Highlights
The widespread use of highly active anti-retroviral therapy (ART) has dramatically increased the longevity of patients infected with the human immune deficiency virus (HIV), with mortality rates falling from 30 at its peak to only 1–3 per 100 person-years. [1,2] Many individuals with HIV infection in Western Countries are living into their 60’s. [3] This improved survival has been driven largely by a marked reduction in deaths from acquired immune deficiency syndrome (AIDS)-defining conditions such as opportunistic infections and AIDS-related malignancies. [4] the impact of ART on non-AIDS defining illnesses has been less impressive
These studies have been relatively small in size and scope or failed to properly phenotype these patients. [10,11,12] The principal aim of the present study was to use thoracic computed tomography (CT) imaging to determine the prevalence of bronchiolitis and emphysema, which is one of the major morphologic phenotypes of chronic obstructive pulmonary disease (COPD) and to describe risk factors associated with these CT phenotypes in a large group of HIV infected individuals who were well treated with ART
Through an in-person interview, we ascertained the subject’s cumulative exposure to major antiretroviral drug classes, including protease inhibitors (PI) and nucleoside reverse transcriptase inhibitors (NRTI), and their physical activity was determined on the basis of whether or not the respondents performed 2 or more hours of exercise per week, which is the minimal level of exercise recommended for achieving health benefits
Summary
The widespread use of highly active anti-retroviral therapy (ART) has dramatically increased the longevity of patients infected with the human immune deficiency virus (HIV), with mortality rates falling from 30 at its peak to only 1–3 per 100 person-years. [1,2] Many individuals with HIV infection in Western Countries are living into their 60’s. [3] This improved survival has been driven largely by a marked reduction in deaths from acquired immune deficiency syndrome (AIDS)-defining conditions such as opportunistic infections and AIDS-related malignancies. [4] the impact of ART on non-AIDS defining illnesses has been less impressive. [6,7] While the effects of HIV on two of the leading non-AIDS defining causes of mortality, cardiovascular disease and solid organ malignancies, have been carefully described and studied, [6,7,8,9] the relation of HIV with chronic obstructive pulmonary disease (COPD), another common senescence-related condition, remains poorly understood. [10,11,12] The principal aim of the present study was to use thoracic computed tomography (CT) imaging to determine the prevalence of bronchiolitis and emphysema, which is one of the major morphologic phenotypes of COPD and to describe risk factors associated with these CT phenotypes in a large group of HIV infected individuals who were well treated with ART. The prevalence or the risk factors associated with emphysema and bronchiolitis are largely unknown
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