Cross sectional analysis of respiratory symptoms in an injection drug user cohort: the impact of obstructive lung disease and HIV.
BACKGROUND
Injection drug use is associated with an increased risk of human immunodeficiency virus (HIV) infection and with obstructive lung diseases (OLD). Understanding how HIV and OLD may impact respiratory symptoms among injection drug users (IDUs) is important to adequately care for this high-risk population. We characterized the independent and joint effects of HIV and OLD on respiratory symptoms of a cohort of inner-city IDUs.


METHODS
Demographics, risk behavior and spirometric measurements were collected from a cross-sectional analysis of the Acquired Immunodeficiency Syndrome Link to the IntraVenous Experience study, an observational cohort of IDUs followed in Baltimore, MD since 1988. Participants completed a modified American Thoracic Society respiratory questionnaire and the Medical Research Council (MRC) dyspnea score to assess respiratory symptoms of cough, phlegm, wheezing and dyspnea.


RESULTS
Of 974 participants, 835 (86%) were current smokers and 288 (29.6%) were HIV-infected. The prevalence of OLD (FEV1/FVC < or = 0.70) was 15.5%, and did not differ by HIV status. OLD, but not HIV, was associated with increased frequency of reported respiratory symptoms. There was a combined effect of OLD and HIV on worsening of MRC scores. OLD and HIV were independently associated with an increased odds of reporting an MRC > or = 2 (OR 1.83 [95%CI 1.23-2.73] and 1.50 [95%CI 1.08-2.09], respectively). COPD, but not HIV, was independently associated with reporting an MRC >/= 3 (OR 2.25 [95%CI 1.43-3.54] and 1.29 [95%CI 0.87-1.91], respectively).


CONCLUSIONS
While HIV does not worsen cough, phlegm or wheezing, HIV significantly increases moderate but not severe dyspnea in individuals of similar OLD status. Incorporating the MRC score into routine evaluation of IDUs at risk for OLD and HIV provides better assessment than cough, phlegm and wheezing alone.
Drummond
M Bradley
MB
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA. mdrummo3@jhmi.edu
Kirk
Gregory D
GD
Ricketts
Erin P
EP
McCormack
Meredith C
MC
Hague
J Christian
JC
McDyer
John F
JF
Mehta
Shruti H
SH
Engels
Eric A
EA
Wise
Robert A
RA
Merlo
Christian A
CA
D000328:Adult; D015142:Baltimore; D015331:Cohort Studies; D003371:Cough / Q000453:epidemiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D055030:Drug Users; D004417:Dyspnea / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012129:Respiratory Function Tests; D012135:Respiratory Sounds; D012307:Risk Factors; D012720:Severity of Illness Index; D013147:Spirometry; D015819:Substance Abuse, Intravenous / Q000150:complications*; D019966:Substance-Related Disorders / Q000453:epidemiology
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