Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Clinical Pharmacy, Epidemiology, Biostatistics and Medicine, University of California, San Francisco, CA.
J Acquir Immune Defic Syndr. 2018 Dec 1;79(4):501-509. doi: 10.1097/QAI.0000000000001840.
HIV is an independent risk factor for chronic obstructive pulmonary disease; however, baseline risk factors for lung function decline remain largely unknown in this population.
HIV-infected participants in the Pittsburgh Lung HIV Cohort with at least 3 pulmonary function measurements between 2007 and 2016 were included. Pulmonary function testing including postbronchodilator (BD) spirometry and diffusion capacity for carbon monoxide (DLco) was performed every 18 months. We used a mixed-effect linear model to evaluate factors associated with pulmonary function testing and DLco decline and logistic regression models to evaluate factors associated with rapid FEV1 decline (defined as >80 mL per year) and any DLco decline.
Two hundred eighty-five HIV-infected participants were included. Median baseline CD4 cell count was 521 cells per micro liter, 61.9% had an undetectable HIV viral load at baseline, and 78.5% were receiving ART. Approximately 20% of participants met Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for a diagnosis of chronic obstructive pulmonary disease at baseline. Older age and baseline GOLD stage 1 compared with stage 0 were associated with faster decline in post-BD FEV1%, whereas female sex was associated with slower decline. Similarly, female sex was associated with slower decline in DLco%. HIV-related factors including CD4 cell count, viral load, and ART use were not significantly associated with pulmonary function decline.
Older age, male sex, and higher baseline GOLD stage were associated with more rapid post-BD FEV1% decline in HIV-infected individuals.
HIV 是慢性阻塞性肺疾病的独立危险因素；然而，在这一人群中，肺功能下降的基线风险因素在很大程度上尚不清楚。
纳入匹兹堡肺 HIV 队列中至少有 3 次肺功能测量值的 HIV 感染参与者，这些测量值是在 2007 年至 2016 年间进行的。每 18 个月进行一次肺功能测试，包括支气管扩张剂后（BD）肺活量测定和一氧化碳弥散量（DLco）。我们使用混合效应线性模型来评估与肺功能测试和 DLco 下降相关的因素，并使用逻辑回归模型来评估与快速 FEV1 下降（定义为每年>80 毫升）和任何 DLco 下降相关的因素。
共纳入 285 名 HIV 感染参与者。中位基线 CD4 细胞计数为每微升 521 个细胞，61.9%的患者基线时 HIV 病毒载量不可检测，78.5%的患者正在接受 ART。大约 20%的参与者在基线时符合全球慢性阻塞性肺疾病倡议（GOLD）诊断慢性阻塞性肺疾病的标准。与基线 GOLD 阶段 0 相比，年龄较大和基线 GOLD 阶段 1 与 BD FEV1%下降较快相关，而女性则与下降较慢相关。同样，女性与 DLco%下降较慢相关。与 HIV 相关的因素，包括 CD4 细胞计数、病毒载量和 ART 使用，与肺功能下降无显著相关性。
在 HIV 感染个体中，年龄较大、男性和较高的基线 GOLD 分期与 BD FEV1%下降较快相关。
