High cytomegalovirus antibody concentrations and lower lung function in persons with HIV who smoke

Persons with HIV (PWH) are at increased risk of chronic obstructive pulmonary disease. The seroprevalence of cytomegalovirus (CMV) is high among PWH, and CMV serology has been associated with accelerated lung function decline in the general population.

To determine whether CMV IgG concentrations were associated with lower lung function in PWH.

: PWH aged 25 years or older and with viral suppression were included from the Copenhagen Comorbidity in HIV infection (COCOMO) study. CMV IgG concentrations were measured using indirect chemiluminescent immunoassay, and high CMV IgG concentrations defined as values above the upper limit of detection (>180 U/mL). Lung function was measured by spirometry as forced expiratory volume in 1 second (FEV1).

Among 987 PWH, 937 (95%) had positive CMV IgG serostatus, and 313 (33%) of the CMV seropositive had high CMV IgG concentrations. High CMV IgG concentrations were associated with lower FEV1 in a linear regression model adjusted for age, sex, smoking status, height, ethnicity and BMI (-86.7 mL [95% CI: -164.5; -8.9], P = .029), but the association was attenuated when additionally adjusted for CD4 + T cell nadir (-67.4 mL [95% CI: -147.0; 12.2], P = .097). Smoking modified the association (p-interaction = 0.001), and the association was more pronounced among current smokers, even in the fully adjusted model (-292.8 mL [-446.5; -139.0], P < .001).

High CMV IgG concentrations were associated with lower lung function among PWH, especially among those who smoke. Further studies are needed to verify CMV as a causal factor in reduced lung function of PWH.