Department of Internal Medicine.
Department of Pulmonary Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands.
AIDS. 2023 Jul 1;37(8):1263-1267. doi: 10.1097/QAD.0000000000003540. Epub 2023 Mar 9.
To assess the impact of past Pneumocystis jirovecii pneumonia (PJP) on the pulmonary diffusion capacity in people with HIV (PWH) with a history of advanced immunodeficiency.
Prospective cross-sectional study.
Adult PWH with past PJP >1 year ago were included as the study group. The control group consisted of PWH with a nadir CD4 + lymphocyte count <200 cells/mm 3 , matched by age, sex, smoking status and time since HIV diagnosis. All PWH completed a pulmonary function test (PFT) consisting of pre-bronchodilation spirometry, body plethysmography and single-breath carbon monoxide transfer factor (TLCO) measurement. TLCO, diffusion impairment (defined as a TLCO Z -score <-1.645), total lung capacity (TLC) and forced expiratory volume in one second/forced vital capacity (FEV1/FVC) Z -scores were assessed. Multivariable regression analyses were conducted with Z -scores and odds of diffusion impairment as outcomes.
PFTs of 102 participants were analyzed, 51 of whom had past PJP with a median of 10 years since PJP. Mean TLCO Z -score and diffusion impairment rate did not differ significantly between groups ( P = 0.790; P = 0.650). Past PJP was not independently associated with TLCO Z -score [ β = 0.14; 95% confidence interval (CI) -0.30-0.57], diffusion impairment (odds ratio 1.00; 95% CI 0.36-2.75) nor TLC or FEV1/FVC Z -scores, whereas current (vs. never) smoking was associated with more diffusion impairment and lower TLCO Z -scores.
In our study, past PJP was not associated with long-term diffusion impairment. Our findings suggest that smoking plays a more important role in persistent pulmonary function impairment whereas PJP-related changes seem to be reversible.
评估过去的卡氏肺孢子虫肺炎（PJP）对过去存在免疫功能低下的人类免疫缺陷病毒（HIV）感染者（PWH）的肺弥散能力的影响。
前瞻性横断面研究。
纳入过去 1 年以上患有 PJP 的成年 PWH 作为研究组。对照组由 HIV 诊断后年龄、性别、吸烟状况和时间匹配的 CD4+淋巴细胞计数<200 个细胞/mm3 的 PWH 组成。所有 PWH 均完成了一项肺功能测试（PFT），包括支气管扩张前肺活量测定、体描法和单次呼吸一氧化碳转移因子（TLCO）测量。评估 TLCO、弥散障碍（定义为 TLCO Z 评分<-1.645）、总肺容量（TLC）和用力呼气量 1 秒/用力肺活量（FEV1/FVC）Z 评分。采用 Z 评分和弥散障碍的比值比作为结局进行多变量回归分析。
对 102 名参与者的 PFT 进行了分析，其中 51 名患有过去的 PJP，距 PJP 发生的中位时间为 10 年。两组之间 TLCO Z 评分和弥散障碍发生率无显著差异（P=0.790；P=0.650）。过去的 PJP 与 TLCO Z 评分无关[β=0.14；95%置信区间（CI）-0.30-0.57]、弥散障碍（比值比 1.00；95% CI 0.36-2.75）或 TLC 或 FEV1/FVC Z 评分，而当前（vs.从未）吸烟与更多的弥散障碍和更低的 TLCO Z 评分相关。
在我们的研究中，过去的 PJP 与长期弥散障碍无关。我们的研究结果表明，吸烟在持续肺功能损害中起着更重要的作用，而 PJP 相关的变化似乎是可逆的。
