Abstract
ObjectiveTo review the incidence of respiratory conditions and their effect on mortality in HIV-infected and uninfected individuals prior to and during the era of highly active antiretroviral therapy (HAART).DesignTwo large observational cohorts of HIV-infected and HIV-uninfected men (Multicenter AIDS Cohort Study [MACS]) and women (Women’s Interagency HIV Study [WIHS]), followed since 1984 and 1994, respectively.MethodsAdjusted odds or hazards ratios for incident respiratory infections or non-infectious respiratory diagnoses, respectively, in HIV-infected compared to HIV-uninfected individuals in both the pre-HAART (MACS only) and HAART eras; and adjusted Cox proportional hazard ratios for mortality in HIV-infected persons with lung disease during the HAART era.ResultsCompared to HIV-uninfected participants, HIV-infected individuals had more incident respiratory infections both pre-HAART (MACS, odds ratio [adjusted-OR], 2.4; 95% confidence interval [CI], 2.2–2.7; p<0.001) and after HAART availability (MACS, adjusted-OR, 1.5; 95%CI 1.3–1.7; p<0.001; WIHS adjusted-OR, 2.2; 95%CI 1.8–2.7; p<0.001). Chronic obstructive pulmonary disease was more common in MACS HIV-infected vs. HIV-uninfected participants pre-HAART (hazard ratio [adjusted-HR] 2.9; 95%CI, 1.02–8.4; p = 0.046). After HAART availability, non-infectious lung diseases were not significantly more common in HIV-infected participants in either MACS or WIHS participants. HIV-infected participants in the HAART era with respiratory infections had an increased risk of death compared to those without infections (MACS adjusted-HR, 1.5; 95%CI, 1.3–1.7; p<0.001; WIHS adjusted-HR, 1.9; 95%CI, 1.5–2.4; p<0.001).ConclusionHIV infection remained a significant risk for infectious respiratory diseases after the introduction of HAART, and infectious respiratory diseases were associated with an increased risk of mortality.
Highlights
The incidence of respiratory diseases and their effect on survival in the era of highly active antiretroviral therapy (HAART) are largely unknown
Human Immunodeficiency Virus (HIV) infection remained a significant risk for infectious respiratory diseases after the introduction of HAART, and infectious respiratory diseases were associated with an increased risk of mortality
In Multicenter AIDS Cohort Study (MACS), the baseline characteristics age, race, ethnicity, smoking status and pack-years of smoking, alcohol use, and intravenous and illicit drug use differed between HIVinfected and -uninfected participants in both the pre-HAART and HAART eras (Table 1)
Summary
The incidence of respiratory diseases and their effect on survival in the era of highly active antiretroviral therapy (HAART) are largely unknown. Few studies have examined changes in respiratory diseases incidence spanning different treatment eras of the Human Immunodeficiency Virus (HIV) epidemic. Infectious respiratory complications of HIV infection have historically been a major cause of morbidity and mortality in the HIV-infected population[1,2,3,4]. The Pulmonary Complications of HIV Study (PCHIS), spanning 1988–1994, demonstrated that HIV-infected individuals had higher rates of upper and lower respiratory infections than HIV-uninfected participants [3]. Epidemiologic and therapeutic changes with respect to HIV infection in the United States severely limit our ability to generalize the findings of the PCHIS and similar studies to the current environment
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