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Processing of Bronchoalveolar Lavage Fluid and Matched Blood for Alveolar Macrophage and CD4+ T-cell Immunophenotyping and HIV Reservoir Assessment
Published on: June 23, 2019
Prevalence and Risk Factors of Preserved Ratio Impaired Spirometry in People With HIV and Matched Population Control
Safura-Luise Heidari1, Josefine Amalie Loft1, Yunus Çolak2
1Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Background:
People with HIV (PWH) have a higher burden of respiratory comorbidities than the general population, yet emerging spirometry impairments such as preserved ratio impaired spirometry (PRISm) and restrictive spirometry patterns (RSPs) have received limited attention.
Research Question:
Is HIV status associated with PRISm and RSP in well-treated PWH residing in high-income settings?
Study Design And Methods:
In a cross-sectional study including 1,080 PWH from the Copenhagen Comorbidity in HIV Infection Study and 12,079 matched population control participants from the Copenhagen General Population Study, we examined the prevalence and explored the association between HIV status and PRISm and RSP. PRISm were defined as FEV1 to FVC ratio equal to or more than the lower limit of normal (LLN) and FEV1 less than the LLN, and RSP was defined as FEV1 to FVC equal to or more than the LLN and FVC less than the LLN. We used multivariable logistic regression analyses and adjusted for HIV-specific and traditional risk factors.
Results:
The prevalence of PRISm and RSP was higher among PWH compared with population control participants (PRISm: 10.5% [95% CI, 8.8%-12.4%] vs 3.5% [95% CI, 3.2%-3.8%]; P < .01; RSP: 10.6% [95% CI, 8.9%-12.6%] vs 3.2% (95% CI, 2.9%-3.5%]; P < .01). These differences persisted in analyses restricted to people who never smoked. HIV was associated with PRISm and RSP in univariable analyses; in models adjusted for age, sex, smoking status, BMI, and educational level (PRISm: OR, 3.58 [95% CI, 2.77-4.63]; RSP: OR, 4.55 [95% CI, 3.51-5.91]), and in fully adjusted models with alcohol consumption, diabetes, and hypertension (PRISm: OR, 3.40 [95% CI, 2.59-4.47]; RSP: OR, 4.34 [95% CI, 3.29-5.73]). PWH with PRISm or RSP showed a higher burden of respiratory symptoms compared with those without.
Interpretation:
PWH showed 3-fold higher prevalences of PRISm and RSP compared with population control participants, and HIV was associated independently with these lung function impairments. PRISm and RSP may represent distinct manifestations of HIV-associated lung function impairment.
Clinical Trial Registration:
ClinicalTrials.gov; No.: NCT02382822; URL: www.
Clinicaltrials:
gov.
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