Airflow limitation in people living with HIV and matched uninfected controls

Introduction: Whether HIV influences pulmonary function remains controversial. We assessed dynamic pulmonary function in people living with HIV (PLWHIV) and uninfected controls.

Methods: A total of 1098 PLWHIV from the Copenhagen Co-morbidity in HIV infection study and 12 161 age-matched and sex-matched controls from the Copenhagen General Population Study were included. Lung function was assessed using FEV₁ and FVC, while airflow limitation was defined by the lower limit of normal (LLN) of FEV₁/FVC and by FEV₁/FVC<0.7 with FEV₁predicted <80% (fixed). Logistic and linear regression models were used to determine the association between HIV and pulmonary function adjusting for potential confounders (including smoking and socioeconomic status).

Results: In predominantly white men with mean (SD) age of 50.6 (11.1) the prevalence of airflow limitation (LLN) was 10.6% (95% CI 8.9% to 12.6%) in PLWHIV and 10.6% (95% CI 10.0 to 11.1) in uninfected controls. The multivariable adjusted OR for airflow limitation defined by LLN for HIV was 0.97 (0.77-1.21, P<0.78) and 1.71 (1.34-2.16, P<0.0001) when defined by the fixed criteria. We found no evidence of interaction between HIV and cumulative smoking in these models (P interaction: 0.25 and 0.17 for LLN and fixed criteria, respectively). HIV was independently associated with 197 mL (152-242, P<0.0001) lower FEV₁ and 395 mL (344-447, P<0.0001) lower FVC, and 100 cells/mm³ lower CD4 nadir was associated with 30 mL (7-52, P<0.01) lower FEV₁ and 51 mL (24-78, P<0.001) lower FVC.

Conclusion: HIV is a risk factor for concurrently decreased FEV₁ and FVC. This excess risk is not explained by smoking or socioeconomic status and may be mediated by prior immunodeficiency.

Trial registration number: NCT02382822.