Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
BMC Pulm Med. 2010 May 11;10:27. doi: 10.1186/1471-2466-10-27.
Injection drug use is associated with an increased risk of human immunodeficiency virus (HIV) infection and with obstructive lung diseases (OLD). Understanding how HIV and OLD may impact respiratory symptoms among injection drug users (IDUs) is important to adequately care for this high-risk population. We characterized the independent and joint effects of HIV and OLD on respiratory symptoms of a cohort of inner-city IDUs.
Demographics, risk behavior and spirometric measurements were collected from a cross-sectional analysis of the Acquired Immunodeficiency Syndrome Link to the IntraVenous Experience study, an observational cohort of IDUs followed in Baltimore, MD since 1988. Participants completed a modified American Thoracic Society respiratory questionnaire and the Medical Research Council (MRC) dyspnea score to assess respiratory symptoms of cough, phlegm, wheezing and dyspnea.
Of 974 participants, 835 (86%) were current smokers and 288 (29.6%) were HIV-infected. The prevalence of OLD (FEV1/FVC < or = 0.70) was 15.5%, and did not differ by HIV status. OLD, but not HIV, was associated with increased frequency of reported respiratory symptoms. There was a combined effect of OLD and HIV on worsening of MRC scores. OLD and HIV were independently associated with an increased odds of reporting an MRC > or = 2 (OR 1.83 [95%CI 1.23-2.73] and 1.50 [95%CI 1.08-2.09], respectively). COPD, but not HIV, was independently associated with reporting an MRC >/= 3 (OR 2.25 [95%CI 1.43-3.54] and 1.29 [95%CI 0.87-1.91], respectively).
While HIV does not worsen cough, phlegm or wheezing, HIV significantly increases moderate but not severe dyspnea in individuals of similar OLD status. Incorporating the MRC score into routine evaluation of IDUs at risk for OLD and HIV provides better assessment than cough, phlegm and wheezing alone.
注射吸毒与人类免疫缺陷病毒（HIV）感染和阻塞性肺疾病（OLD）的风险增加有关。了解 HIV 和 OLD 如何影响注射吸毒者（IDU）的呼吸症状对于为这一高危人群提供充分的护理至关重要。我们描述了 HIV 和 OLD 对城市内 IDU 呼吸症状的独立和联合影响。
从 1988 年以来在马里兰州巴尔的摩进行的观察性 IDU 队列的获得性免疫缺陷综合征与静脉内经验研究的横断面分析中收集了人口统计学、风险行为和肺量计测量数据。参与者完成了改良的美国胸科学会呼吸问卷和医学研究委员会（MRC）呼吸困难评分，以评估咳嗽、咳痰、喘息和呼吸困难的呼吸症状。
在 974 名参与者中，835 名（86%）为当前吸烟者，288 名（29.6%）为 HIV 感染者。OLD（FEV1/FVC<或=0.70）的患病率为 15.5%，与 HIV 状态无关。OLD 而不是 HIV 与报告的呼吸症状频率增加有关。OLD 和 HIV 对 MRC 评分恶化有共同影响。OLD 和 HIV 与报告 MRC>或=2 的可能性增加独立相关（OR 1.83[95%CI 1.23-2.73]和 1.50[95%CI 1.08-2.09]）。COPD 而不是 HIV 与报告 MRC>或=3 的可能性增加独立相关（OR 2.25[95%CI 1.43-3.54]和 1.29[95%CI 0.87-1.91]）。
虽然 HIV 不会加重咳嗽、咳痰或喘息，但 HIV 会显著增加 OLD 状态相似的个体的中度但不是严重的呼吸困难。与单独咳嗽、咳痰和喘息相比，将 MRC 评分纳入有 OLD 和 HIV 风险的 IDU 的常规评估中提供了更好的评估。
