10.5061/DRYAD.ST5RK
Gupte, Akshay N.
Johns Hopkins University School of Medicine
Wong, Michelle L.
University of the Witwatersrand
Masandiwa, Reginah
Barnes, Grace L.
Johns Hopkins University School of Medicine
Golub, Jonathan
Johns Hopkins University School of Medicine
Chaisson, Richard E.
Johns Hopkins University School of Medicine
Hoffmann, Christopher J.
Johns Hopkins University School of Medicine
Martinson, Neil A.
University of the Witwatersrand
Johns Hopkins University School of Medicine
Msandiwa, Reginah
University of the Witwatersrand
Data from: Factors associated with pulmonary impairment in HIV-infected
South African adults
Dryad
dataset
2018
2018-09-01T00:00:00Z
2018-09-01T00:00:00Z
en
https://doi.org/10.1371/journal.pone.0184530
350067 bytes
1
CC0 1.0 Universal (CC0 1.0) Public Domain Dedication
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.
PONE-D-17-17716