Department of Family Medicine, University of California, Los Angeles, California.
Department of Epidemiology.
AIDS. 2021 Jul 15;35(9):1451-1460. doi: 10.1097/QAD.0000000000002914.
People with HIV (PWH) experience increased prevalence of obstructive lung disease (OLD), regardless of greater observed smoking behaviors. We investigated whether the effect of incident OLD on mortality differed by HIV and HIV viral suppression among persons who inject drugs (PWID) and report smoking history.
ALIVE is a longitudinal, observational cohort study of HIV-positive and seronegative PWID. This analysis included participants who had at least one spirometry measure to assess OLD between 2007 and 2016, excluding those who never smoked (5%, n = 62) or had baseline OLD (17%, n = 269).
Incident OLD occurred when the first prebronchodilator forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) less than 0.70 during follow-up. The effect of incident OLD on all-cause mortality was estimated in PWH and seronegative participants using inverse-probability-of-treatment-weighted marginal structural models controlling for baseline (age, race, sex, calendar year, smoking pack-years) and time-varying (smoking intensity, viral suppression, and calendar time) confounders.
Among 1204 participants, 269 (22.3%) and 157 (13.0%) experienced incident OLD and death, respectively, over a median of five person-years of follow-up. There was no effect of OLD on mortality among seronegative participants [hazard ratio = 0.84, 95% confidence interval (CI): 0.47-1.48]; however, PWH diagnosed with OLD experienced an increased mortality risk (hazard ratio = 1.71, 95% CI: 1.04-2.80) during follow-up. HIV viral suppression did not confound or modify the effect of OLD on mortality among PWH.
There was an apparent effect of OLD on all-cause mortality irrespective of viral suppression among PWH but not among seronegative persons, after accounting for baseline and time-varying confounders. These results highlight the need for enhanced screening and management of OLD among PWH.
无论观察到的吸烟行为如何增加，艾滋病毒感染者（PWH）的阻塞性肺疾病（OLD）患病率均升高。我们研究了在有吸毒史的人群（PWID）中，新发 OLD 对死亡率的影响是否因 HIV 和 HIV 病毒抑制而有所不同。
ALIVE 是一项针对 HIV 阳性和阴性 PWID 的纵向观察性队列研究。本分析包括在 2007 年至 2016 年间至少有一次肺量计测量以评估 OLD 的参与者，但不包括从未吸烟（5%，n=62）或基线时已有 OLD（17%，n=269）的参与者。
在随访过程中，当首次预支气管扩张剂用力呼气量 1 秒（FEV1）/用力肺活量（FVC）小于 0.70 时，诊断为新发 OLD。使用逆概率治疗加权边缘结构模型，通过基线（年龄、种族、性别、日历年份、吸烟包年数）和随时间变化的（吸烟强度、病毒抑制和日历时间）混杂因素来估计 PWH 和血清阴性参与者中，新发 OLD 对全因死亡率的影响。
在 1204 名参与者中，分别有 269 名（22.3%）和 157 名（13.0%）在中位随访 5 人年期间发生 OLD 和死亡。在血清阴性参与者中，OLD 对死亡率没有影响[危险比=0.84，95%置信区间（CI）：0.47-1.48]；然而，诊断为 OLD 的 PWH 在随访期间的死亡率风险增加（危险比=1.71，95%CI：1.04-2.80）。HIV 病毒抑制并未影响或改变 OLD 对 PWH 死亡率的影响。
在考虑了基线和随时间变化的混杂因素后，在 PWH 中，OLD 对全因死亡率的影响明显，无论病毒抑制情况如何，但在血清阴性人群中则不然。这些结果强调了需要加强对 PWH 中 OLD 的筛查和管理。
