title: Cross sectional analysis of respiratory symptoms in an injection drug user cohort: the impact of obstructive lung disease and HIV.
abstract: 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.
authors.affiliation: Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA. mdrummo3@jhmi.edu
authors.forename: M Bradley
authors.initials: MB
authors.lastname: Drummond
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kirk
authors.forename: Erin P
authors.initials: EP
authors.lastname: Ricketts
authors.forename: Meredith C
authors.initials: MC
authors.lastname: McCormack
authors.forename: J Christian
authors.initials: JC
authors.lastname: Hague
authors.forename: John F
authors.initials: JF
authors.lastname: McDyer
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.forename: Eric A
authors.initials: EA
authors.lastname: Engels
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wise
authors.forename: Christian A
authors.initials: CA
authors.lastname: Merlo
mesh_terms: 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
references.citation: Am J Respir Crit Care Med. 1997 Jan;155(1):72-80
references.pmid: 9001292
references.citation: Thorax. 1999 Jul;54(7):581-6
references.pmid: 10377201
references.citation: Infect Dis Clin North Am. 2002 Sep;16(3):697-712
references.pmid: 12371123
references.citation: Am J Public Health. 1996 May;86(5):642-54
references.pmid: 8629714
references.citation: Am J Med. 1988 Sep;85(3):289-91
references.pmid: 3414726
references.citation: Am J Respir Crit Care Med. 1999 Jan;159(1):179-87
references.pmid: 9872837
references.citation: Am Rev Respir Dis. 1978 Dec;118(6 Pt 2):1-120
references.pmid: 742764
references.citation: NIDA Res Monogr. 1991;109:75-100
references.pmid: 1661376
references.citation: Ann Intern Med. 1992 Jan 15;116(2):124-8
references.pmid: 1727615
references.citation: Curr Opin Pulm Med. 2002 Mar;8(2):81-6
references.pmid: 11845001
references.citation: Proc R Soc Med. 1952 Sep;45(9):577-84
references.pmid: 13003946
references.citation: Clin Infect Dis. 2007 Jul 1;45(1):103-10
references.pmid: 17554710
references.citation: Ann Intern Med. 2000 Mar 7;132(5):369-72
references.pmid: 10691587
references.citation: Respir Med. 2007 Jan;101(1):146-53
references.pmid: 16713225
references.citation: Chest. 1999 Dec;116(6):1632-7
references.pmid: 10593787
references.citation: Chest. 1987 Dec;92(6):1085-7
references.pmid: 3677815
references.citation: AIDS. 1988 Aug;2(4):267-72
references.pmid: 3140832
references.citation: Am J Public Health. 1998 Jan;88(1):108-13
references.pmid: 9584014
references.citation: Chest. 1994 Sep;106(3):827-34
references.pmid: 8082366
references.citation: AIDS. 1996 Oct;10(12):1349-56
references.pmid: 8902063
references.citation: Chest. 2006 Nov;130(5):1326-33
references.pmid: 17099007
references.citation: AIDS. 1987 Jul;1(2):67-76
references.pmid: 3130084
references.citation: PLoS One. 2009 Jul 21;4(7):e6328
references.pmid: 19621086
references.citation: Chest. 2002 May;121(5):1434-40
references.pmid: 12006425
references.citation: Clin Infect Dis. 2000 Apr;30 Suppl 1:S77-84
references.pmid: 10770916
references.citation: Eur Respir J. 2005 Aug;26(2):319-38
references.pmid: 16055882
references.citation: Am J Gastroenterol. 1998 May;93(5):785-9
references.pmid: 9625128
references.citation: Postgrad Med. 2009 Sep;121(5):56-67
references.pmid: 19820275
references.citation: Infect Dis Clin North Am. 2002 Sep;16(3):535-51, vii
references.pmid: 12371114
references.citation: N Engl J Med. 2004 Mar 4;350(10):1005-12
references.pmid: 14999112
references.citation: AIDS. 1992 Aug;6(8):843-8
references.pmid: 1329849
references.citation: Diagn Mol Pathol. 2005 Mar;14(1):48-52
references.pmid: 15714064
references.citation: Chest. 2003 Jun;123(6):1977-82
references.pmid: 12796177
references.citation: Clin Infect Dis. 1995 Jun;20(6):1467-79
references.pmid: 7548494
references.citation: J Gen Intern Med. 2005 Dec;20(12):1142-5
references.pmid: 16423106
references.citation: AIDS. 2007 Jan 11;21(2):207-13
references.pmid: 17197812
references.citation: Clin Exp Immunol. 1993 Aug;93(2):149-51
references.pmid: 8348739
references.citation: J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Dec 1;13(4):374-83
references.pmid: 8948377
references.citation: AIDS Res Hum Retroviruses. 1994 Dec;10(12):1619-27
references.pmid: 7888221
references.citation: AIDS. 2007 Nov 30;21(18):2435-43
references.pmid: 18025880
references.citation: Natl Vital Stat Rep. 2009 Apr 17;57(14):1-134
references.pmid: 19788058
references.citation: Am J Med. 1980 Feb;68(2):231-7
references.pmid: 7355894