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Asthma
Influence of HIV status on the management of acute asthma exacerbations
  1. Muhammad Adrish1,
  2. Gabriella Roa Gomez2,
  3. Enny Cancio Rodriguez3 and
  4. Nikhitha Mantri2
  1. 1Clinical Assistant Professor, Medicine, BronxCare Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, NY, USA, Bronx, New York, USA
  2. 2Medicine, BronxCare Hospital Center, Bronx, New York, USA
  3. 3Medicine, Kendall Regional Medical Center, Miami, Florida, USA
  1. Correspondence to Dr Muhammad Adrish; aadrish{at}hotmail.com

Abstract

Background An increased incidence of asthma has been suggested in patients with HIV. We aimed to compare the outcomes of HIV-positive and HIV-negative patients following hospital admission for asthma exacerbation.

Methods A retrospective chart review of patients hospitalised between January 2015 and December 2017 owing to asthma exacerbation with a known HIV status was conducted.

Results During the study period, 1242 patients with asthma were admitted. Of these, 462 patients had a known HIV status (358 HIV-negative, 104 HIV-positive) and were included. No differences in baseline demographics, including age, sex, body mass index and underlying comorbid conditions, were identified between the groups except that HIV-negative patients had higher incidence of underlying congestive heart failure. HIV-positive group had a significantly higher serum creatinine levels (1.117 (1.390) vs 0.813 (0.509), p=0.001), higher serum eosinophil levels (492.91 (1789.09) vs 243.70 (338.66), p=0.013) but had lower serum neutrophils (5.74 (3.18) vs 7.194 (3.59), p=0.0002) and lower serum albumin levels (3.754 (0.480) vs 3.94 (0.443), p=0.003) than the HIV-negative group, respectively. Non-invasive positive pressure ventilation (NIPPV) use was more frequent (54.8% vs 25.4%, p≤0.001) and the length of in-hospital stay (LOS) was longer in HIV-positive vs HIV-negative patients (3.346 days vs 2.813 days, p=0.015); no differences in mechanical ventilation use or intensive care unit admission were noted between the groups. In a subgroup analysis comparing HIV-negative with HIV-positive patients stratified by CD4 count, NIPPV use was more frequent and the LOS was longer in HIV-positive patients with CD4 counts≥200 cellsx 10∧6/L. In a multivariable regression model, HIV-positive status was independently associated with NIPPV use (OR 2.52; 95% CI 1.43 to 4.46) and a 0.55 day (95% CI 0.02 to 1.08) longer LOS in hospital.

Conclusions HIV-positive patients admitted with asthma exacerbation are more likely to require NIPPV and have longer LOS.

  • asthma

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjresp-2019-000472

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    Footnotes

    • Contributors MA had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. MA, GRG, ECR and NM contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by our Institutional Review Board (IRB# 03081805) at BronxCare Hospital Center, Bronx, NY, USA.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.