title: The determinants of poor respiratory health status in adults living with human immunodeficiency virus infection.
abstract: The increased longevity afforded by combination antiretroviral therapy in developed countries has led to an increased concern regarding senescence-related diseases in patients with human immunodeficiency virus (HIV) infection. Previous epidemiologic analyses have demonstrated an increased risk of chronic obstructive pulmonary disease, as well as a significant burden of respiratory symptoms in HIV-infected patients. We performed the St. George's Respiratory Questionnaire (SGRQ) in 199 HIV-positive men, and determined the predominant factors contributing to poor respiratory-related health status. In univariate analyses, worse SGRQ scores were associated with respiratory-related variables such as greater smoking pack-year history (p=0.028), lower forced expiratory volume in 1 second (FEV1) (p<0.001), and worse emphysema severity as quantified by computed tomographic imaging (p=0.017). In addition, HIV-specific variables, such as a history of plasma viral load >100,000 copies/mL (p=0.043), lower nadir CD4 cell count (p=0.040), and current CD4 cell count ≤350 cells/μL (p=0.005), as well as elevated levels of inflammatory markers, specifically plasma interleukin (IL)-6 (p=0.002) and alpha-1 antitrypsin (p=0.005) were also associated with worse SGRQ scores. In a multiple regression model, FEV1, current CD4 count ≤350 cells/μL, and IL-6 levels remained significant contributors to reduced respiratory-related health status. HIV disease activity as measured by HIV-related immunosuppression in conjunction with the triggering of key inflammatory pathways may be important determinants of worse respiratory health status among HIV-infected individuals. Limitations of this analysis include the absence of available echocardiograms, diffusion capacity and lung volume testing, and an all-male cohort due to the demographics of the clinic population.
authors.affiliation: 1 UBC James Hogg Research Centre , Vancouver, BC, Canada .
authors.forename: Janice M
authors.initials: JM
authors.lastname: Leung
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Liu
authors.forename: Andy
authors.initials: A
authors.lastname: Mtambo
authors.forename: David
authors.initials: D
authors.lastname: Ngan
authors.forename: Negar
authors.initials: N
authors.lastname: Nashta
authors.forename: Silvia
authors.initials: S
authors.lastname: Guillemi
authors.forename: Marianne
authors.initials: M
authors.lastname: Harris
authors.forename: Viviane D
authors.initials: VD
authors.lastname: Lima
authors.forename: Andre
authors.initials: A
authors.lastname: Mattman
authors.forename: Tawimas
authors.initials: T
authors.lastname: Shaipanich
authors.forename: Rekha
authors.initials: R
authors.lastname: Raju
authors.forename: Cameron
authors.initials: C
authors.lastname: Hague
authors.forename: Jonathon A
authors.initials: JA
authors.lastname: Leipsic
authors.forename: Don D
authors.initials: DD
authors.lastname: Sin
authors.forename: Julio S
authors.initials: JS
authors.lastname: Montaner
authors.forename: S F Paul
authors.initials: SF
authors.lastname: Man
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015992:Body Mass Index; D001955:British Columbia; D018791:CD4 Lymphocyte Count; D005541:Forced Expiratory Volume; D015658:HIV Infections / Q000503:physiopathology*; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D016014:Linear Models; D008168:Lung / Q000503:physiopathology*; D008173:Lung Diseases, Obstructive / Q000503:physiopathology*; D008297:Male; D012044:Regression Analysis; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors; D013147:Spirometry; D011795:Surveys and Questionnaires; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents