title: Pulmonary symptoms and diagnoses are associated with HIV in the MACS and WIHS cohorts.
abstract: BACKGROUND
  Several lung diseases are increasingly recognized as comorbidities with HIV; however, few data exist related to the spectrum of respiratory symptoms, diagnostic testing, and diagnoses in the current HIV era. The objective of the study is to determine the impact of HIV on prevalence and incidence of respiratory disease in the current era of effective antiretroviral treatment.
  
  
  METHODS
  A pulmonary-specific questionnaire was administered yearly for three years to participants in the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS). Adjusted prevalence ratios for respiratory symptoms, testing, or diagnoses and adjusted incidence rate ratios for diagnoses in HIV-infected compared to HIV-uninfected participants were determined. Risk factors for outcomes in HIV-infected individuals were modeled.
  
  
  RESULTS
  Baseline pulmonary questionnaires were completed by 907 HIV-infected and 989 HIV-uninfected participants in the MACS cohort and by 1405 HIV-infected and 571 HIV-uninfected participants in the WIHS cohort. In MACS, dyspnea, cough, wheezing, sleep apnea, and incident chronic obstructive pulmonary disease (COPD) were more common in HIV-infected participants. In WIHS, wheezing and sleep apnea were more common in HIV-infected participants. Smoking (MACS and WIHS) and greater body mass index (WIHS) were associated with more respiratory symptoms and diagnoses. While sputum studies, bronchoscopies, and chest computed tomography scans were more likely to be performed in HIV-infected participants, pulmonary function tests were no more common in HIV-infected individuals. Respiratory symptoms in HIV-infected individuals were associated with history of pneumonia, cardiovascular disease, or use of HAART. A diagnosis of asthma or COPD was associated with previous pneumonia.
  
  
  CONCLUSIONS
  In these two cohorts, HIV is an independent risk factor for several respiratory symptoms and pulmonary diseases including COPD and sleep apnea. Despite a higher prevalence of chronic respiratory symptoms, testing for non-infectious respiratory diseases may be underutilized in the HIV-infected population.
authors.affiliation: Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. gingomr@upmc.edu.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Gingo
authors.forename: Goundappa K
authors.initials: GK
authors.lastname: Balasubramani
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Rice
authors.forename: Lawrence
authors.initials: L
authors.lastname: Kingsley
authors.forename: Eric C
authors.initials: EC
authors.lastname: Kleerup
authors.forename: Roger
authors.initials: R
authors.lastname: Detels
authors.forename: Eric C
authors.initials: EC
authors.lastname: Seaberg
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Greenblatt
authors.forename: Susan
authors.initials: S
authors.lastname: Holman
authors.forename: Laurence
authors.initials: L
authors.lastname: Huang
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Sutton
authors.forename: Marnie
authors.initials: M
authors.lastname: Bertolet
authors.forename: Alison
authors.initials: A
authors.lastname: Morris
mesh_terms: D000328:Adult; D017677:Age Distribution; D023241:Antiretroviral Therapy, Highly Active; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology; D012120:Respiration Disorders / Q000175:diagnosis / Q000453:epidemiology; D012129:Respiratory Function Tests; D012140:Respiratory Tract Diseases / Q000175:diagnosis / Q000453:epidemiology; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D014481:United States