Department of Medicine, University of Washington, Seattle, USA.
Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
AIDS. 2018 Jun 19;32(10):1353-1359. doi: 10.1097/QAD.0000000000001815.
As life expectancy of people living with HIV (PLWH) improves in low-income and middle-income countries (LMICs), the spectrum of HIV-related pulmonary complications may reflect a greater burden of chronic lung diseases as in high-income countries. We determined whether the risk of abnormal spirometry was greater among adolescent compared with adult PLWH at the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya, and evaluated the role of other cofactors for abnormal spirometry.
We prospectively enrolled adolescent and adult PLWH for this cross-sectional study.
Data collection included standardized questionnaires, clinical assessment, and prebronchodilator and postbronchodilator spirometry. Adolescents additionally underwent noncontrast chest computed tomography. Multivariable logistic regression determined associations of adolescent age with abnormal spirometry, adjusting for cofactors.
Of 427 PLWH, 21 (40%) adolescents and 64 (17%) adults had abnormal spirometry. Among adolescents, 80% had abnormal chest CTs, and 79% had at least one respiratory symptom. Adolescent age (adjusted odds ratio 3.22; 95% confidence interval 1.48-6.98) was independently associated with abnormal spirometry, adjusting for recent CD4, HIV clinical stage, low BMI, indoor kerosene use, smoking pack-years, and prior pulmonary tuberculosis. Additional important cofactors for abnormal spirometry included prior pulmonary tuberculosis (3.15; 1.70-5.58), kerosene use (1.77; 1.04-3.04) and smoking pack-years (1.05; 1.00-1.10). Adolescent age, prior pulmonary tuberculosis, and smoking pack-years were significantly associated with airflow limitation.
Adolescent age was independently associated with increased risk of abnormal spirometry, particularly airflow limitation. Studies to improve prevention, detection, and management of chronic lung disease across the lifespan among PLWH are needed in LMICs.
在中低收入国家（LMICs），随着艾滋病毒感染者（PLWH）预期寿命的延长，与艾滋病毒相关的肺部并发症谱可能反映出慢性肺部疾病的负担更大，就像高收入国家一样。我们在肯尼亚内罗毕的科普特希望传染病中心确定了与成人 PLWH 相比，青少年 PLWH 发生异常肺活量测定的风险是否更高，并评估了其他混杂因素对异常肺活量测定的作用。
我们前瞻性地招募了青少年和成年 PLWH 进行这项横断面研究。
数据收集包括标准化问卷、临床评估以及支气管扩张前和支气管扩张后肺活量测定。青少年还接受了非对比性胸部计算机断层扫描。多变量逻辑回归确定了青少年年龄与异常肺活量测定之间的关联，同时调整了混杂因素。
在 427 名 PLWH 中，21 名（40%）青少年和 64 名（17%）成年人的肺活量测定异常。在青少年中，80%的人胸部 CT 异常，79%的人至少有一种呼吸道症状。青少年年龄（调整后的优势比 3.22；95%置信区间 1.48-6.98）与异常肺活量测定独立相关，同时调整了近期 CD4、HIV 临床分期、低 BMI、室内煤油使用、吸烟包年数和既往肺结核。异常肺活量测定的其他重要混杂因素包括既往肺结核（3.15；1.70-5.58）、煤油使用（1.77；1.04-3.04）和吸烟包年数（1.05；1.00-1.10）。青少年年龄、既往肺结核和吸烟包年数与气流受限显著相关。
青少年年龄与异常肺活量测定的风险增加独立相关，特别是气流受限。在 LMICs 中，需要进行研究以改善 PLWH 整个生命周期的慢性肺部疾病的预防、检测和管理。
