title: The impact of HAART on the respiratory complications of HIV infection: longitudinal trends in the MACS and WIHS cohorts.
abstract: OBJECTIVE
  To 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).
  
  
  METHODS
  Two 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.
  
  
  METHODS
  Adjusted 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.
  
  
  RESULTS
  Compared 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Gingo
authors.forename: G K
authors.initials: GK
authors.lastname: Balasubramani
authors.forename: Lawrence
authors.initials: L
authors.lastname: Kingsley
authors.forename: Charles R
authors.initials: CR
authors.lastname: Rinaldo
authors.forename: Christine B
authors.initials: CB
authors.lastname: Alden
authors.forename: Roger
authors.initials: R
authors.lastname: Detels
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Greenblatt
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Hessol
authors.forename: Susan
authors.initials: S
authors.lastname: Holman
authors.forename: Laurence
authors.initials: L
authors.lastname: Huang
authors.forename: Eric C
authors.initials: EC
authors.lastname: Kleerup
authors.forename: John
authors.initials: J
authors.lastname: Phair
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Sutton
authors.forename: Eric C
authors.initials: EC
authors.lastname: Seaberg
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Margolick
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Alison
authors.initials: A
authors.lastname: Morris
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008171:Lung Diseases / Q000453:epidemiology / Q000209:etiology; D008297:Male; D012120:Respiration Disorders / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
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