Effect of Human Immunodeficiency Virus on Lung Function and Structure: A Systematic Review and Meta-Analysis

Rationale: Obstructive lung disease (OLD) pathogenesis includes inhalational (e.g., smoking) and noninhalational mechanisms (e.g., infections). Human immunodeficiency virus (HIV) has been suggested as a novel OLD risk factor. Substantial data have recently emerged about its effects on lung function and structure, especially in low- to middle-income countries and regarding longitudinal lung function. Objectives: To assess the association of HIV infection with OLD, impaired gas exchange, and emphysema. Methods: In this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Global Index Medicus through April 2023 for controlled and observational studies of people living with and without HIV reporting pulmonary function and/or emphysema. Primary outcomes were OLD by spirometry, gas exchange impairment by diffusing capacity of the lung for carbon monoxide, and visual emphysema by computed tomography. We performed random-effects meta-analyses using odds ratios (ORs) with 95% confidence intervals (CIs). This study was registered in PROSPERO (CRD42021268498). Results: We included 95 publications pertaining to 43 unique studies. HIV was associated with OLD (OR, 1.29; 95% CI, 1.02-1.63), impaired gas exchange (OR, 2.63; 95% CI, 0.96-7.24), emphysema (OR, 1.46; 95% CI, 1.02-2.09), and faster lung function decline. OLD risk was greatest in Africans with HIV. There were no gas exchange or emphysema data from Africa. The certainty of evidence was low to very low, primarily because of studies' observational design. Conclusions: People living with HIV have increased risk for OLD, gas exchange impairment, faster lung function decline, and emphysema. OLD risk in HIV varies regionally. We recommend that both spirometry and diffusing capacity of the lung for carbon monoxide be measured in people living with HIV and respiratory symptoms. Future studies should develop and validate HIV-specific screening and case-finding strategies for chronic lung disease.