Brown J, McGowan J A, Chouial H, Capocci S, Smith C, Ivens D, Johnson M, Sathia L, Shah R, Lampe F C, Rodger A, Lipman M
Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK.
UCL Respiratory, Division of Medicine, University College London, London, UK.
HIV Med. 2017 Sep;18(8):604-612. doi: 10.1111/hiv.12497. Epub 2017 Mar 13.
We sought to evaluate whether people living with HIV (PLWH) using effective antiretroviral therapy (ART) have worse respiratory health status than similar HIV-negative individuals.
We recruited 197 HIV-positive and 93 HIV-negative adults from HIV and sexual health clinics. They completed a questionnaire regarding risk factors for respiratory illness. Respiratory health status was assessed using the St George's Respiratory Questionnaire (SGRQ) and the Medical Research Council (MRC) breathlessness scale. Subjects underwent spirometry without bronchodilation.
PLWH had worse respiratory health status: the median SGRQ Total score was 12 [interquartile range (IQR) 6-25] in HIV-positive subjects vs. 6 (IQR 2-14) in HIV-negative subjects (P < 0.001); breathlessness was common in the HIV-positive group, where 47% compared with 24% had an MRC breathlessness score ≥ 2 (P = 0.001). Eighteen (11%) HIV-positive and seven (9%) HIV-negative participants had airflow obstruction. In multivariable analyses (adjusted for age, gender, smoking, body mass index and depression), HIV infection remained associated with higher SGRQ and MRC scores, with an adjusted fold-change in SGRQ Total score of 1.54 [95% confidence interval (CI) 1.14-2.09; P = 0.005] and adjusted odds ratio of having an MRC score of ≥ 2 of 2.45 (95% CI 1.15-5.20; P = 0.02). Similar findings were obtained when analyses were repeated including only HIV-positive participants with a viral load < 40 HIV-1 RNA copies/mL.
Despite effective ART, impaired respiratory health appears more common in HIV-positive adults, and has a significant impact on health-related quality of life.
我们试图评估接受有效抗逆转录病毒治疗（ART）的艾滋病毒感染者（PLWH）的呼吸健康状况是否比类似的艾滋病毒阴性个体更差。
我们从艾滋病毒和性健康诊所招募了197名艾滋病毒阳性和93名艾滋病毒阴性成年人。他们完成了一份关于呼吸道疾病危险因素的问卷。使用圣乔治呼吸问卷（SGRQ）和医学研究委员会（MRC）呼吸困难量表评估呼吸健康状况。受试者在未使用支气管扩张剂的情况下进行肺功能测定。
艾滋病毒感染者的呼吸健康状况更差：艾滋病毒阳性受试者的SGRQ总分中位数为12[四分位间距（IQR）6 - 25]，而艾滋病毒阴性受试者为6（IQR 2 - 14）（P < 0.001）；呼吸困难在艾滋病毒阳性组中很常见，其中47%的人MRC呼吸困难评分为≥2，而艾滋病毒阴性组为24%（P = 0.001）。18名（11%）艾滋病毒阳性和7名（9%）艾滋病毒阴性参与者存在气流受限。在多变量分析（调整年龄、性别、吸烟、体重指数和抑郁因素后）中，艾滋病毒感染仍与较高的SGRQ和MRC评分相关，SGRQ总分的调整后变化倍数为1.54[95%置信区间（CI）1.14 - 2.09；P = 0.005]，MRC评分≥2的调整后比值比为2.45（95% CI 1.15 - 5.20；P = 0.02）。当仅对病毒载量<40个艾滋病毒-1 RNA拷贝/mL的艾滋病毒阳性参与者重复分析时，得到了类似的结果。
尽管有有效的抗逆转录病毒治疗，但呼吸健康受损在艾滋病毒阳性成年人中似乎更常见，并且对与健康相关的生活质量有重大影响。
