Lorenz David R, Uno Hajime, Wolinsky Steven M, Gabuzda Dana
Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, USA.
Center for Population Science, Dana-Farber Cancer Institute, Boston, MA, USA.
EClinicalMedicine. 2019 Jan;7:55-64. doi: 10.1016/j.eclinm.2019.01.003. Epub 2019 Jan 24.
Lung disease is a common comorbidity in people with HIV/AIDS, independent of smoking status. The effects of marijuana smoking on risk of lung disease in HIV-infected individuals are unclear.
In this prospective cohort study, we quantified lung disease risk among men enrolled in the Multicenter AIDS Cohort Study (MACS), a long-term observational cohort of HIV-infected and uninfected men who have sex with men. Eligible participants were aged ≥30 years with self-reported marijuana and tobacco smoking data from biannual study visits between 1996 and 2014. Pulmonary diagnoses were obtained from self-report and medical records. Analyses were performed using Cox models and Generalized Estimating Equations adjusted for tobacco smoking, CD4 T cell count, and other risk factors.
1,630 incident pulmonary diagnoses were reported among 1,352 HIV-seropositive and 1,352 HIV-seronegative eligible participants matched for race and baseline age (53,794 total person-visits, median follow-up 10.5 years). 27% of HIV-infected participants reported daily or weekly marijuana smoking for one or more years in follow-up, compared to 18% of uninfected participants (median 4·0 and 4·5 years daily/weekly use, respectively). HIV-infected participants had an increased likelihood of infectious or non-infectious pulmonary diagnoses compared to uninfected participants (33·2% vs. 21·5%, and 20·6% vs. 17·2%, respectively). Among HIV-infected participants, recent marijuana smoking was associated with increased risk of infectious pulmonary diagnoses and chronic bronchitis independent of tobacco smoking and other risk factors for lung disease (hazard ratio [95% confidence interval] 1·43 [1·09-1·86], and 1·54 [1·11-2·13], respectively); these risks were additive in participants smoking both substances. There was no association between marijuana smoking and pulmonary diagnoses in HIV-uninfected participants.
In this longitudinal study, long-term marijuana smoking was associated with lung disease independent of tobacco smoking and other risk factors in HIV-infected individuals. These findings could be used to reduce modifiable risks of lung disease in high-risk populations.
肺部疾病是人类免疫缺陷病毒/获得性免疫综合征（HIV/AIDS）患者中常见的合并症，与吸烟状况无关。吸食大麻对HIV感染者肺部疾病风险的影响尚不清楚。
在这项前瞻性队列研究中，我们对参与多中心艾滋病队列研究（MACS）的男性的肺部疾病风险进行了量化，MACS是一个对感染和未感染HIV的男同性恋者进行长期观察的队列。符合条件的参与者年龄≥30岁，有1996年至2014年期间每半年一次研究访视时自我报告的大麻和烟草使用数据。肺部诊断来自自我报告和医疗记录。分析使用Cox模型和广义估计方程进行，并对吸烟、CD4 T细胞计数和其他风险因素进行了调整。
在1352名HIV血清阳性和1352名HIV血清阴性的符合条件的参与者（按种族和基线年龄匹配，共53794人次随访，中位随访时间10.5年）中，报告了1630例新发肺部诊断。27%的HIV感染者报告在随访中每天或每周吸食大麻持续一年或更长时间，而未感染参与者的这一比例为18%（每天/每周使用大麻的中位时间分别为4.0年和4.5年）。与未感染参与者相比，HIV感染者发生感染性或非感染性肺部诊断的可能性增加（分别为33.2%对21.5%，以及20.6%对17.2%）。在HIV感染者中，近期吸食大麻与感染性肺部诊断和慢性支气管炎风险增加相关，且独立于吸烟和其他肺部疾病风险因素（风险比[95%置信区间]分别为1.43[1.09 - 1.86]和1.54[1.11 - 2.13]）；在同时吸食这两种物质的参与者中，这些风险具有叠加性。在未感染HIV的参与者中，吸食大麻与肺部诊断之间没有关联。
在这项纵向研究中，长期吸食大麻与HIV感染者的肺部疾病相关，且独立于吸烟和其他风险因素。这些发现可用于降低高危人群中可改变的肺部疾病风险。
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