Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
Departments of Epidemiology.
J Acquir Immune Defic Syndr. 2024 Nov 1;97(3):282-285. doi: 10.1097/QAI.0000000000003490.
People with HIV (PWH) have nearly twice the risk of emphysema than people without HIV. This risk, which has been associated with HIV-mediated changes in the lung immune environment and more extensive radiographic emphysema, may result in different patterns of airflow limitation on pulmonary function testing (PFT) than those traditionally used in people without HIV.
In this prospective cohort of PWH in Atlanta, Georgia, we analyzed PFT and chest computed tomography data from July 2013 through June 2018. After comparing the prevalence of PFT measures of airflow limitation for those with and without radiographic emphysema, we used binary recursive partitioning to identify PFT measures that differentiated between PWH with and without radiographic emphysema.
Among 167 PWH who had both PFT and computed tomography data during the study period, 89 (53%) had radiographic emphysema. Those with radiographic emphysema were more likely to have airflow limitations on PFTs. Recursive partitioning identified partitions at a forced expiratory volume in 1 second to forced vital capacity ratio (FEV1/FVC) of 0.78 and a residual volume of 116% predicted. These partitions enabled the identification of 84 (94%) PWH with radiographic emphysema, in contrast to the traditional diagnostic criteria of an FEV1/FVC ratio of 0.7, which only identified 49 (55%) of those with radiographic emphysema.
Emphysema in PWH may have different patterns of airflow limitation on PFTs that are not adequately captured by traditional diagnostic criteria. Future studies can seek to validate these findings and determine optimal thresholds for diagnosing HIV-associated emphysema.
与未感染 HIV 的人群相比，HIV 感染者（PWH）患肺气肿的风险几乎高出两倍。这种风险与 HIV 介导的肺部免疫环境改变以及更广泛的放射学肺气肿有关，可能导致肺功能测试（PFT）的气流受限模式与未感染 HIV 的人群传统使用的模式不同。
在佐治亚州亚特兰大的这项前瞻性 HIV 感染者队列研究中，我们分析了 2013 年 7 月至 2018 年 6 月期间的 PFT 和胸部计算机断层扫描数据。在比较了有和无放射学肺气肿的 PFT 气流受限测量值的患病率后，我们使用二元递归分区来确定区分有和无放射学肺气肿的 PFT 测量值。
在研究期间同时具有 PFT 和计算机断层扫描数据的 167 名 HIV 感染者中，有 89 名（53%）患有放射学肺气肿。这些患有放射学肺气肿的患者更有可能在 PFT 上出现气流受限。递归分区确定了在一秒用力呼气量与用力肺活量的比值（FEV1/FVC）为 0.78 和残气量为 116%预计值的分区。这些分区能够识别出 84 名（94%）患有放射学肺气肿的 HIV 感染者，而传统的诊断标准为 FEV1/FVC 比值为 0.7，只能识别出 49 名（55%）患有放射学肺气肿的患者。
HIV 感染者的肺气肿可能在 PFT 上具有不同的气流受限模式，而传统的诊断标准无法充分捕捉到这些模式。未来的研究可以验证这些发现，并确定诊断 HIV 相关肺气肿的最佳阈值。
