Gingo Matthew R, Balasubramani Goundappa K, Rice Thomas B, Kingsley Lawrence, Kleerup Eric C, Detels Roger, Seaberg Eric C, Greenblatt Ruth M, Holman Susan, Huang Laurence, Sutton Sarah H, Bertolet Marnie, Morris Alison
Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
BMC Pulm Med. 2014 Apr 30;14:75. doi: 10.1186/1471-2466-14-75.
Several lung diseases are increasingly recognized as comorbidities with HIV; however, few data exist related to the spectrum of respiratory symptoms, diagnostic testing, and diagnoses in the current HIV era. The objective of the study is to determine the impact of HIV on prevalence and incidence of respiratory disease in the current era of effective antiretroviral treatment.
A pulmonary-specific questionnaire was administered yearly for three years to participants in the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS). Adjusted prevalence ratios for respiratory symptoms, testing, or diagnoses and adjusted incidence rate ratios for diagnoses in HIV-infected compared to HIV-uninfected participants were determined. Risk factors for outcomes in HIV-infected individuals were modeled.
Baseline pulmonary questionnaires were completed by 907 HIV-infected and 989 HIV-uninfected participants in the MACS cohort and by 1405 HIV-infected and 571 HIV-uninfected participants in the WIHS cohort. In MACS, dyspnea, cough, wheezing, sleep apnea, and incident chronic obstructive pulmonary disease (COPD) were more common in HIV-infected participants. In WIHS, wheezing and sleep apnea were more common in HIV-infected participants. Smoking (MACS and WIHS) and greater body mass index (WIHS) were associated with more respiratory symptoms and diagnoses. While sputum studies, bronchoscopies, and chest computed tomography scans were more likely to be performed in HIV-infected participants, pulmonary function tests were no more common in HIV-infected individuals. Respiratory symptoms in HIV-infected individuals were associated with history of pneumonia, cardiovascular disease, or use of HAART. A diagnosis of asthma or COPD was associated with previous pneumonia.
In these two cohorts, HIV is an independent risk factor for several respiratory symptoms and pulmonary diseases including COPD and sleep apnea. Despite a higher prevalence of chronic respiratory symptoms, testing for non-infectious respiratory diseases may be underutilized in the HIV-infected population.
几种肺部疾病越来越多地被认为是HIV的合并症；然而，在当前HIV时代，关于呼吸道症状谱、诊断检测和诊断的数据很少。本研究的目的是确定在当前有效的抗逆转录病毒治疗时代，HIV对呼吸道疾病患病率和发病率的影响。
对多中心艾滋病队列研究（MACS）和女性机构间HIV研究（WIHS）的参与者每年进行为期三年的肺部专项问卷调查。确定了HIV感染者与未感染HIV参与者相比呼吸道症状、检测或诊断的调整患病率比值以及诊断的调整发病率比值。对HIV感染者结局的危险因素进行了建模。
MACS队列中有907名HIV感染者和989名未感染HIV的参与者完成了基线肺部问卷调查，WIHS队列中有1405名HIV感染者和571名未感染HIV的参与者完成了基线肺部问卷调查。在MACS中，呼吸困难、咳嗽、喘息、睡眠呼吸暂停和新发慢性阻塞性肺疾病（COPD）在HIV感染者中更为常见。在WIHS中，喘息和睡眠呼吸暂停在HIV感染者中更为常见。吸烟（MACS和WIHS）和更高的体重指数（WIHS）与更多的呼吸道症状和诊断相关。虽然HIV感染者更有可能进行痰液研究、支气管镜检查和胸部计算机断层扫描，但肺功能测试在HIV感染者中并不更常见。HIV感染者的呼吸道症状与肺炎病史、心血管疾病或使用高效抗逆转录病毒治疗（HAART）有关。哮喘或COPD的诊断与既往肺炎有关。
在这两个队列中，HIV是几种呼吸道症状和肺部疾病（包括COPD和睡眠呼吸暂停）的独立危险因素。尽管慢性呼吸道症状的患病率较高，但在HIV感染人群中，对非感染性呼吸道疾病的检测可能未得到充分利用。
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