Minneapolis VA Health Care System, Minneapolis, MN.
University of Minnesota, Minneapolis, MN.
J Acquir Immune Defic Syndr. 2018 Nov 1;79(3):e85-e92. doi: 10.1097/QAI.0000000000001797.
Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability globally. Both cigarette smoking and HIV have been identified as independent risk factors for COPD. We used data from the strategic timing of antiretroviral treatment (START) Pulmonary Substudy to quantify the impact of smoking on rate of lung function decline in HIV.
We included START Pulmonary Substudy participants who contributed at least 2 good quality spirometry measures during the study. Slope of forced expiratory volume in 1 second (FEV1) was estimated using a repeated-measures model adjusted for the treatment group (immediate vs deferred treatment arm of START), age, sex, race, baseline COPD, and region.
Of 1026 START Pulmonary Substudy participants, 915 (89%) were included in this analysis. Median follow-up time was 3.9 years. Smokers and nonsmokers were similar in baseline age (median 36 years), but smokers were more likely to be white, male, and from Europe/Israel/Australia. Smokers had faster average FEV1 decline compared with nonsmokers [-38.3 mL/yr vs -25.1 mL/yr; difference of -13.2 mL/yr (95% confidence interval: -23.6 to -2.7); P = 0.013], were more likely to meet criteria for rapid FEV1 decline [7.2%-11.7% more likely (P = 0.09-P = 0.002), depending on the definition of rapid decline], and had borderline, but not statistically significant, higher incident COPD during follow-up (9.7% vs 5.8%, P = 0.06).
Compared to nonsmokers, HIV-positive smokers experience faster decline in lung function. These results underscore the need for a better understanding of how to best support smoking cessation among HIV-positive populations.
慢性阻塞性肺疾病（COPD）是全球范围内导致死亡和残疾的主要原因。吸烟和 HIV 都被确定为 COPD 的独立危险因素。我们使用战略时机抗逆转录病毒治疗（START）肺部子研究的数据，来量化吸烟对 HIV 患者肺功能下降速度的影响。
我们纳入了至少在研究期间提供了 2 次高质量肺活量测定值的 START 肺部子研究参与者。使用重复测量模型估算 1 秒用力呼气量（FEV1）的斜率，该模型调整了治疗组（START 的立即治疗组和延迟治疗组）、年龄、性别、种族、基线 COPD 和地区。
在 1026 名 START 肺部子研究参与者中，有 915 名（89%）参与者纳入本分析。中位随访时间为 3.9 年。吸烟者和非吸烟者在基线年龄（中位数 36 岁）方面相似，但吸烟者更可能是白人、男性且来自欧洲/以色列/澳大利亚。与非吸烟者相比，吸烟者的 FEV1 平均下降速度更快[-38.3 mL/yr 与 -25.1 mL/yr；差值-13.2 mL/yr（95%置信区间：-23.6 至 -2.7）；P=0.013]，更有可能符合快速 FEV1 下降的标准[根据快速下降的定义，可能性增加 7.2%-11.7%（P=0.09-P=0.002）]，并且在随访期间 COPD 的发生率更高（9.7%比 5.8%，P=0.06），但无统计学意义。
与非吸烟者相比，HIV 阳性吸烟者的肺功能下降更快。这些结果强调了需要更好地了解如何最好地支持 HIV 阳性人群戒烟。
