Data from: Factors associated with pulmonary impairment in HIV-infected South African adults

Background: HIV-infected individuals have increased risk of developing
obstructive lung disease (OLD). Studies from developed countries report
high viral load, low CD4 counts, and anti-retroviral therapy (ART) to be
associated with OLD; but these findings may not be generalizable to
populations in resource-limited settings. Methods: We conducted a
prospective cohort study of lung function in 730 HIV-infected black South
African adults. Pre-bronchodilator spirometry was performed at enrollment
and repeated annually for three years. Logistic regression models were
used to identify factors associated with OLD, defined as
FEV1/FVC<0.70, at enrollment. Excess annual declines in FEV1 and
FVC were modelled as the product-term of follow-up time and exposures
using random effects regression. Results: Median (IQR) age at enrollment
was 36 (32-41) years, 85% were female and 30% ever-smoked with a median
(IQR) exposure of 3 (1-6) pack-years. Median (IQR) CD4 count and viral
load at enrollment were 372 (261-518) cells/mm3 and 2655 (91-13,548)
copies/mL respectively. Overall, 25% were receiving ART at enrollment, 16%
of whom reported at least 6 months of ART receipt. OLD was found in 35
(5%) at enrollment. Increasing age (aOR=2.08 per 10-years [95%CI
1.22-3.57], p=0.007), current smoking (aOR=3.55 [95%CI 1.20-10.53],
p=0.02), and CRP (aOR=1.01 per unit-increase [95%CI 1.00-1.03], p=0.04)
were significantly associated with OLD at enrollment; while increasing CD4
count (aOR=1.02 per-100 cells/mm3 [95%CI 0.85-1.22], p=0.82), viral load
(aOR=0.67 per log-increase [95%CI 0.43-1.10], p=0.12) and receipt of ART
(aOR=0.57 [95%CI 0.18-1.75], p=0.32) were not. The median (IQR) follow-up
time was 18 (12-24) months. Participants with a history of tuberculosis
(TB) had a 35 mL (95%CI 2-68, p=0.03) and 57 mL (95%CI 19-96, p=0.003) per
year excess loss of FEV1 and FVC respectively. Conclusion: Prevalent OLD
was associated with older age, current smoking and higher CRP levels, but
not CD4 counts and ART, in HIV-infected South African adults. Better
understanding of the long-term effects of TB, smoking and inflammation on
lung function in HIV-infected populations is urgently needed.