title: HIV infection is associated with reduced pulmonary diffusing capacity.
abstract: BACKGROUND
  Prior studies comparing abnormalities in pulmonary function between HIV-infected and HIV-uninfected persons in the current era are limited.
  
  
  OBJECTIVE
  To determine the pattern and severity of impairment in pulmonary function in HIV-infected compared with HIV-uninfected individuals.
  
  
  METHODS
  Cross-sectional analysis of 300 HIV-infected men and 289 HIV-uninfected men enrolled from 2009 to 2011 in 2 clinical centers of the Lung HIV Study. Participants completed pre- and postbronchodilator spirometry, diffusing capacity of the lung for carbon monoxide (DLCO) measurement, and standardized questionnaires.
  
  
  RESULTS
  Most participants had normal airflow; 18% of HIV-infected and 16% of HIV-uninfected men had airflow obstruction. The mean percent predicted DLCO was 69% in HIV-infected vs. 76% in HIV-uninfected men (P < 0.001). A moderately to severely reduced DLCO of ≤60% was observed in 30% of HIV-infected compared with 18% of HIV-uninfected men (P < 0.001), despite the fact that 89% of those with HIV were on antiretroviral therapy. A reduced DLCO was significantly associated with HIV and CD4 cell count in linear regression adjusting for smoking and other confounders. The DLCO was lowest in HIV-infected men with CD4 cell counts <200 cells per microliter compared with those with CD4 cell counts ≥200 cells per microliter and to HIV-uninfected men. Respiratory symptoms of cough, phlegm and dyspnea were more prevalent in HIV-infected patients particularly those with abnormal pulmonary function compared with HIV-uninfected patients.
  
  
  CONCLUSIONS
  HIV infection is an independent risk factor for reduced DLCO, particularly in individuals with a CD4 cell count below 200 cells per microliter. Abnormalities in pulmonary function among HIV-infected patients manifest clinically with increased respiratory symptoms. Mechanisms accounting for the reduced DLCO require further evaluation.
authors: *Department of Medicine, University of Washington, Seattle, WA; †Department of Medicine, University of Pittsburgh, Pittsburgh, PA; ‡Department of Medicine, University of California, Los Angeles, Los Angeles, CA; §Department of Medicine, Atlanta Veterans Affairs Medical Center (VAMC) and Emory University, Atlanta, GA; ‖Department of Medicine, West Los Angeles VAMC and David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA; ¶Department of Medicine, James J. Peters Bronx VAMC, Bronx, NY; #Department of Medicine, Michael E. DeBakey Houston VAMC and Baylor College of Medicine, Houston, TX; **Department of Medicine, University of California, San Francisco, San Francisco, CA; ††Department of Medicine, Clinical Trials and Survey Corporation, Owings Mills, MD; ‡‡Department of Medicine, Ohio State University Medical Center, Columbus, OH; §§Department of Medicine, Johns Hopkins University, Baltimore, MD; ‖‖Department of Medicine, New York University School of Medicine, New York, NY; ¶¶Departments of Infectious Diseases and Microbiology; and Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; and ##Departments of Medicine and Immunology, University of Pittsburgh, Pittsburgh, PA.
authors: Kristina
authors: K
authors: Crothers
authors: Kathleen
authors: K
authors: McGinnis
authors: Eric
authors: E
authors: Kleerup
authors: Cherry
authors: C
authors: Wongtrakool
authors: Guy S
authors: GS
authors: Hoo
authors: Joon
authors: J
authors: Kim
authors: Amir
authors: A
authors: Sharafkhaneh
authors: Laurence
authors: L
authors: Huang
authors: Zhaoyu
authors: Z
authors: Luo
authors: Bruce
authors: B
authors: Thompson
authors: Philip
authors: P
authors: Diaz
authors: Gregory D
authors: GD
authors: Kirk
authors: William
authors: W
authors: Rom
authors: Roger
authors: R
authors: Detels
authors: Lawrence
authors: L
authors: Kingsley
authors: Alison
authors: A
authors: Morris
mesh_terms: D000367:Age Factors; D018791:CD4 Lymphocyte Count; D003371:Cough / Q000209:etiology / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology*; D015658:HIV Infections / Q000150:complications / Q000503:physiopathology* / Q000821:virology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011653:Pulmonary Diffusing Capacity; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology* / Q000821:virology; D012129:Respiratory Function Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014728:Veterans; D019562:Viral Load
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