title: Contributors to diffusion impairment in HIV-infected persons.
abstract: Abnormal diffusing capacity is common in HIV-infected individuals, including never smokers. Aetiologies for diffusing capacity impairment in HIV are not understood, particularly in those without a history of cigarette smoking. Our study was a cross-sectional analysis of 158 HIV-infected individuals without acute respiratory symptoms or infection with the aim to determine associations between a diffusing capacity of the lung for carbon monoxide (D(LCO)) % predicted and participant demographics, pulmonary spirometric measures (forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity), radiographic emphysema (fraction of lung voxels < -950 Hounsfield units), pulmonary vascular/cardiovascular disease (echocardiographic tricuspid regurgitant jet velocity, N-terminal pro-brain natriuretic peptide) and airway inflammation (induced sputum cell counts), stratified by history of smoking. The mean D(LCO) was 65.9% predicted, and 55 (34.8%) participants had a significantly reduced D(LCO) (<60% predicted). Lower D(LCO) % predicted in ever-smokers was associated with lower post-bronchodilator FEV1 % predicted (p<0.001) and greater radiographic emphysema (p=0.001). In never-smokers, mean±SD D(LCO) was 72.7±13.4% predicted, and D(LCO) correlated with post-bronchodilator FEV1 (p=0.02), sputum neutrophils (p=0.03) and sputum lymphocytes (p=0.009), but not radiographic emphysema. Airway obstruction, emphysema and inflammation influence D(LCO) in HIV. Never-smokers may have a unique phenotype of diffusing capacity impairment. The interaction of multiple factors may account for the pervasive nature of diffusing capacity impairment in HIV infection.
authors: University of Pittsburgh, Pittsburgh, PA.
authors: Matthew R
authors: MR
authors: Gingo
authors: Jiayan
authors: J
authors: He
authors: Catherine
authors: C
authors: Wittman
authors: Carl
authors: C
authors: Fuhrman
authors: Joseph K
authors: JK
authors: Leader
authors: Cathy
authors: C
authors: Kessinger
authors: Lorrie
authors: L
authors: Lucht
authors: William A
authors: WA
authors: Slivka
authors: Yingze
authors: Y
authors: Zhang
authors: Deborah K
authors: DK
authors: McMahon
authors: Frank C
authors: FC
authors: Sciurba
authors: Alison
authors: A
authors: Morris
mesh_terms: D000328:Adult; D002248:Carbon Monoxide; D002318:Cardiovascular Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D005541:Forced Expiratory Volume; D064426:Gasotransmitters; D015658:HIV Infections / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011652:Pulmonary Circulation / Q000502:physiology*; D011653:Pulmonary Diffusing Capacity / Q000502:physiology*; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000209:etiology; D011859:Radiography; D012907:Smoking; D014797:Vital Capacity
chemical_list: D064426:Gasotransmitters; D002248:Carbon Monoxide