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Faster lung function decline in well-treated people
living with HIV compared with uninfected controls:
a longitudinal matched cohort study
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EACS 2021 Oct 27-30 Rebekka F. Thudium, Andreas Ronit, Shoaib Afzal, Yunus Çolak, Julie L. Forman, Fernando Mendo, Fabian Chen, Vicente Estrada, Nagalingeswaran Kumarasamy, Børge G. Nordestgaard, Jens Lundgren, Jørgen Vestbo, Ken M. Kunisaki, Susanne D. Nielsen
[for the COCOMO, INSIGHT START Pulmonary Substudy and CGPS Study Groups]
Faster Lung Function Drop With HIV in Danish Matched Cohorts
18th European AIDS Conference, EACS 2021, October 27-30, 2021, London
Mark Mascolini
Compared with HIV-negative people matched by age and sex, middle-aged people with HIV had an 8.5-mL/year faster decline in lung function in a longitudinal analysis [1]. This difference held true when researchers divided participants into current smokers, former smokers, and never smokers, with the greatest difference in current smokers.
Although research links HIV infection to heightened risk of chronic lung disease [2], only a few studies have charted lung function over time in people with HIV [3]. Researchers at the University of Copenhagen and collaborators at other centers conducted this study to compare rates of age-related waning lung function in antiretroviral responders and HIV-negative controls matched by age and sex.
The analysis included two HIV cohorts, the Copenhagen Comorbidity in HIV Infection (COCOMO) Study and the INSIGHT Strategic Timing of Antiretroviral Therapy (START) pulmonary substudy. HIV-negative controls came from the Copenhagen General Population Study. Researchers matched every HIV-positive person to at least 2 HIV-negative people by age (within 5 years) and sex. Participants had to be at least 25 years old and have 2 spirometry tests to measure lung function separated by at least 2 years of follow-up. People with HIV had to be taking antiretroviral therapy for at least 6 months. To compare lung function changes in the two groups, researchers used linear mixed models including fixed variables (age, sex, ethnicity, smoking status) and random effects.
The 1130 people with HIV were marginally younger than the 2895 HIV-negative controls (average 46.6 vs 49.2 years) and included a lower proportion of Caucasians (70.1% vs 99.9%) and a higher proportion of current smokers (28.2% vs 18.5%). Similar proportions of HIV-positive and negative people were men (81.9% and 79.8%). Most people with HIV (93.7%) had a viral load below 50 copies. Current CD4 count averaged 732 in the HIV group, and time with HIV averaged 10.6 years.
Average FEV1 (forced expiratory volume in 1 second) was lower in the HIV group (3.4 vs 3.7 L), as was average FVC (forced vital capacity, the total amount of air exhaled in the FEV fest) (4.4 vs 4.6 L). The linear mixed model analysis of FEV1 decline from age 25 to 90 determined that people with HIV had an 8.5 mL/year faster drop (95% confidence interval [CI] 5.6 to 11.4, P < 0.001). Adjusted subgroup analyses found that this greater lung function loss with HIV held true for current smokers (16.8 mL/year), former smokers (7.2 mL/year), and never smokers (5.0 mL/years) (interaction P = 0.001). HIV infection was independently associated with doubled odds of rapid FEV1 decline (adjusted odds ratio 1.98, 95% CI 1.67 to 2.34). FVC also dropped significantly faster in people with versus without HIV (-17.7 mL/year, 95% CI -21.5 to -14.0, P < 0.001).
Because FEV1 fell faster with HIV in current smokers, the researchers suggested that smoking jeopardizes lung function more in people with than without HIV. But because HIV-positive people who never smoked also lost lung function faster than HIV-negative controls, the investigators speculated that "mechanisms independent of smoking may also play a role."
References
1. Thudium RF, Ronit A, Afzal S, et al. Faster lung function decline in well-treated people living with HIV compared with uninfected controls: a longitudinal matched cohort study. 18th European AIDS Conference, EACS 2021, October 27-30, 2021, London. Abstract OS2/2.
2. Bigna JJ, Kenne AM, Asangbeh SL, Sibetcheu AT. Prevalence of chronic obstructive pulmonary disease in the global population with HIV: a systematic review and meta-analysis. Lancet Glob Health. 2018;6:e193-e202. doi: 10.1016/S2214-109X(17)30451-5.
3. Drummond MB, Merlo CA, Astemborski J, et al. The effect of HIV infection on longitudinal lung function decline among IDUs: a prospective cohort. AIDS. 2013;27:1303-11. doi: 10.1097/QAD.0b013e32835e395d.
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