title: Pulmonary function in an international sample of HIV-positive, treatment-naïve adults with CD4 counts > 500 cells/μL: a substudy of the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial.
abstract: OBJECTIVE
  The aim of the study was to describe the prevalence and correlates of chronic obstructive pulmonary disease (COPD) in a multicentre international cohort of persons living with HIV (PLWH).
  
  
  METHODS
  We performed a cross-sectional analysis of adult PLWH, naïve to HIV treatment, with baseline CD4 cell count > 500 cells/μL enrolled in the Pulmonary Substudy of the Strategic Timing of AntiRetroviral Treatment (START) trial. We collected standardized, quality-controlled spirometry. COPD was defined as forced expiratory volume in 1 s:forced vital capacity (FEV1 :FVC) ratio less than the lower limit of normal.
  
  
  RESULTS
  Among 1026 participants from 80 sites and 20 countries, the median age was 36 [interquartile range (IQR) 30, 44] years, 29% were female, and the median time since HIV diagnosis was 1.2 (IQR 0.4, 3.5) years. Baseline median CD4 cell count was 648 (IQR 583, 767) cells/μL, median viral load was 4.2 (IQR 3.5, 4.7) log10 HIV-1 RNA copies/mL, and 10% had a viral load ≤ 400 copies/mL despite lack of HIV treatment. Current/former/never smokers comprised 28%/11%/61% of the cohort, respectively. COPD was present in 6.8% of participants, and varied by age, smoking status and region. Forty-eight per cent of those with COPD reported lifelong nonsmoking. In multivariable regression, age and pack-years of smoking had the strongest associations with FEV1 :FVC ratio (P < 0.0001). There was a significant effect of region on FEV1 :FVC ratio (P = 0.010).
  
  
  CONCLUSIONS
  Our data suggest that, among PLWH who were naïve to HIV treatment and had CD4 cell counts > 500 cells/μL, smoking and age were important factors related to COPD. Smoking cessation should remain a high global priority for clinical care and research in PLWH.
authors.affiliation: Minneapolis VA Health Care System, Minneapolis, MN, USA; University of Minnesota, Minneapolis, MN, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Kunisaki
authors.forename: D E
authors.initials: DE
authors.lastname: Niewoehner
authors.forename: G
authors.initials: G
authors.lastname: Collins
authors.forename: D E
authors.initials: DE
authors.lastname: Nixon
authors.forename: E
authors.initials: E
authors.lastname: Tedaldi
authors.forename: C
authors.initials: C
authors.lastname: Akolo
authors.forename: C
authors.initials: C
authors.lastname: Kityo
authors.forename: H
authors.initials: H
authors.lastname: Klinker
authors.forename: A
authors.initials: A
authors.lastname: La Rosa
authors.forename: J E
authors.initials: JE
authors.lastname: Connett
mesh_terms: D000328:Adult; D000367:Age Factors; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013147:Spirometry
keywords: HIV; Strategic Timing of AntiRetroviral Treatment (START) trial; pulmonary disease; smoking; spirometry