Effect of HIV on respiratory symptoms, health status, and exertional capacity

People with HIV (PWH) have increased risk for worse pulmonary function and increased emphysema. HIV has been proposed as a risk factor for respiratory patient-reported outcomes (PROs). We assessed the association of HIV with respiratory symptoms, respiratory health status, and functional exercise capacity.

Systematic review and meta-analysis.

We searched PubMed, EMBASE, CENTRAL, CDSR, WoS, Scopus, CINAHL, and GIM through November 2023 for studies of PWH and people without HIV (PWOH) reporting respiratory PROs. Primary outcomes were activity-limiting dyspnea (defined as Modified Medical Research Council Dyspnea Scale score ≥2), respiratory health status by St. George's Respiratory Questionnaire (SGRQ), and exertional capacity by 6-min walking distance (6MWD). We performed random-effects meta-analyses estimating odds ratios (ORs) and mean differences with 95% confidence intervals (CIs).

We included 89 publications corresponding to 56 studies. HIV was associated with activity-limiting dyspnea (OR 1.67; 95% CI 1.05-2.65), worse respiratory health status (SGRQ mean difference 2.9 units; 95% CI 0.6-5.2), worse exertional capacity (6MWD mean difference -58.9 m; 95% CI -115.3 to -2.4), and chronic cough, dyspnea, phlegm, and wheeze (OR 1.38-1.78). Respiratory symptom and adverse respiratory health status risk was greatest in European PWH. Certainty of evidence was very low, primarily due to studies' observational design and inconsistency.

PWH have increased risk for worse respiratory PROs. Systematic respiratory PRO assessment should be incorporated into routine clinical care to facilitate active case-finding of chronic lung disease in PWH. Future studies should longitudinally co-assess objective physiologic measures and respiratory PROs.