Abnormal Airway Function in Individuals with the Acquired Immunodeficiency Syndrome

doi:10.1378/chest.94.5.945

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Volume 94, Issue 5, November 1988, Pages 945-948

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Pulmonary function test results of individuals with the acquired immunodeficiency syndrome (AIDS) were analyzed to determine the prevalence of abnormally low forced expiratory flow rates and bronchial hyperreactivity. Of 99 individuals with AIDS, a total of 44 (44 percent) had either low forced expiratory flow rates or a significant response to inhaled bronchodilator. Thirty-one (31 percent) individuals exhibited significant improvement in airflow rates after bronchodilator inhalation, while 33 (33 percent) had low flow rates. Twenty (20 percent) individuals had both low flow rates and a significant response to bronchodilator. In 83 percent of symptomatic individuals treated with bronchodilators there was clinical improvement. Thus, we conclude that abnormally low forced expiratory flow rate with or without bronchial hyperreactivity is a common and treatable complication of AIDS.

Section snippets

Sample Selection and Testing Procedures

The New England Deaconess Hospital is a 500-bed university-affiliated hospital in Boston where approximately 25 percent of all those in Massachusetts with AIDS have received treatment since 1983. Between January 1, 1983, and July 31, 1986, 153 individuals with AIDS were treated at this institution. Of these individuals, 105 were referred to the pulmonary function laboratory. In all cases, the diagnosis of AIDS was established by the criteria outlined by the Centers for Disease Control.⁸ The

Prevalence of Abnormal Airway Function in AIDS

From January 1983 to July 1986, 105 AIDS patients were referred for pulmonary physiologic assessment. Ninety-nine (94.3 percent) of these individuals were able to perform three FVC maneuvers acceptable for analysis. The 105 patients referred to the PFT lab represent 68.6 percent of those with AIDS who were treated as either inpatients or outpatients at the New England Deaconess Hospital. The mean age of this group was 34.6 (± 8.2 SD) years. Seventy-two percent of these individuals were tested

DISCUSSION

This study demonstrates the frequent occurrence of abnormal airway function among individuals with AIDS. In this sample, we found that 44 percent of subjects had either abnormally low forced expiratory flow rates or a significant response to inhaled bronchodilator. Abnormal function was more prevalent among individuals with systemic KS than it was among those with the diagnosis of PCP, but was most common among those with neither PCP nor KS.

Although a prevalence rate for bronchospastic disorder

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Cited by (46)

Airway hyperresponsiveness and inflammation in Japanese patients with human immunodeficiency virus 1 infection
2022, Journal of Infection and Chemotherapy
Despite the growing population of long-term survivors with human immunodeficiency virus 1 (HIV) exhibiting asthma-like features worldwide, the pathogenesis underlying airway hyperresponsiveness (AHR) and airway inflammation remains unclear. We aimed to investigate AHR and airway inflammation in an HIV-infected Japanese population.
Of 94 Japanese participants, 10 HIV-infected participants with asthma were excluded from the study. We compared the characteristics of HIV-infected (n = 34) and non-HIV-infected participants (n = 50). Eosinophilic, neutrophilic, mixed (eosinophilic and neutrophilic), and paucigranulocytic airway inflammatory phenotypes were classified based on induced sputum characteristics.
The prevalence of AHR in HIV-infected participants (32.4%) was significantly higher than that in their non-HIV-infected counterparts (10.0%) (P = 0.0213). The multivariate nominal logistic regression analysis revealed HIV as an independent risk factor for AHR. HIV-infected participants were significantly more likely to have a neutrophilic airway inflammatory phenotype than non-HIV-infected participants (P = 0.0358). Furthermore, HIV-infected participants with AHR demonstrated a significant correlation between AHR levels and the percentage of sputum neutrophils (r = −0.65, P = 0.0316). The percentage of sputum neutrophils was negatively associated with the blood CD4 cell count (r = −0.66, P = 0.0266).
We observed the high prevalence of AHR and neutrophilic airway inflammatory phenotype in Japanese participants with stable HIV infection. Our findings provide insight into the mechanisms of AHR and may facilitate the development of novel treatment for individuals with AHR and HIV infection.
Pulmonary Complications of HIV Infection
2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth Edition
Factors associated with inspiratory muscle weakness in patients with HIV-1
2015, Brazilian Journal of Infectious Diseases
the impact of human immunodeficiency virus type 1 (HIV-1) on lung function is well known and associated with a reduction in pulmonary ventilation. Moreover, the use of highly active antiretroviral therapy has been associated with mitochondrial dysfunction and decreased muscle strength. However, there is scarce information about the factors associated with inspiratory muscle weakness in these patients.
the purpose of the present study was to investigate the factors associated with inspiratory muscle weakness in patients with HIV-1.
two-hundred fifty seven patients with HIV-1 were screened and categorized into two groups: (1) IMW+ (n = 142) and (2) IMW− (n = 115). Lung function (FEV₁, FVC and FEV₁/FVC), maximum inspiratory pressure, distance on the six-minute walk test and CD4 cell count were assessed.
the mean duration of HIV infection was similar in the two groups. The following variables were significantly different between groups: mean duration of highly active antiretroviral therapy (81 ± 12 in IMW+ versus 38 ± 13 months in IMW−; p = 0.01), and CD4 cell count (327 ± 88 in IMW+ versus 637 ± 97 cells/mm³ in IMW−; p = 0.02). IMW+ presented reduced lung function (FEV1, FVC, FEV1/FVC).
patients with IMW+ had lower distance on the six-minute walk test in comparison to the IMW− group. The duration of highly active antiretroviral therapy, distance traveled on the 6MWT and CD4 count were determinants of IMW in patients with HIV.
HIV in the lung from 1982 to 2013
2014, Revue des Maladies Respiratoires
Tout au long des 30 dernières années, l’atteinte pulmonaire a joué un rôle de premier plan dans l’histoire de l’infection par le VIH. Initialement, la survenue inexpliquée de pneumocystoses a révélé l’émergence du sida et fait suspecter son origine africaine. Avant l’ère des trithérapies, l’histoire naturelle du sida a été dominée par la survenue d’infections pulmonaires itératives et le pneumologue a été en première ligne pour leur diagnostic, leur traitement et leur prophylaxie. Avec la mise à disposition des traitements antirétroviraux, l’histoire naturelle du sida a été transformée chez les patients pouvant en bénéficier. À côté de cas de réactions paradoxales observés à l’introduction des trithérapies, le pneumologue est confronté, à un stade chronique mais contrôlé de l’infection par le VIH, à des manifestations inattendues dont l’incidence croît avec le temps : hypertension artérielle pulmonaire et cancer du poumon, certainement, BPCO et fibrose, peut-être… mais cette histoire reste encore à écrire.
During the last 30 years pulmonary involvement has played a major role in the history of HIV infection. Initially, the unexplained occurrence of pneumocystis revealed the emergence of AIDS and the suspicion of its African origin. Before the era of triple therapy the natural history of AIDS was dominated by the occurrence of repeated lung infections and respiratory physicians were at the forefront of their diagnosis, treatment and prophylaxis. With the provision of antiretroviral therapy (ART), the natural history of AIDS has been transformed in those patients who benefit from it. In addition to paradoxical reactions observed following the introduction of ART, the pulmonologist is also facing a chronic stage of controlled HIV infection, and unexpected events, the incidence of which increases with time: pulmonary arterial hypertension and lung cancer certainly, COPD and fibrosis perhaps… but this story remains to be written.
Human Immunodeficiency Virus and Allergic Disease
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HIV and asthma, is there an association?
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Citation Excerpt :
In the pre-HAART era, O’Donnell et al.56 analyzed pulmonary function testing on 105 AIDS patients in the Boston area from 1983 through 1986. Abnormally decreased forced expiratory flow rates or significant response to bronchodilators consistent with obstructive lung disease was observed in 44% of their subjects.56 However, further analysis of their data demonstrates a temporal relationship between obstructive pattern on spirometry and acute Pneumocystis pneumonia.
To evaluate whether asthma and airway hyper-responsiveness are associated with HIV infection.
We reviewed the literature on HIV-associated pulmonary diseases, pulmonary symptoms, and immune changes which may play a role in asthma. The information was analyzed comparing the pre-HAART era to the post-HAART era data.
HIV-seropositive individuals commonly experience respiratory complaints yet it is unclear if the frequency of these complaints have changed with the initiation of HAART. Changes in pulmonary function testing and serum IgE are seen with HIV infection even in the post-HAART era. An increased prevalence of asthma among HIV-seropositive children treated with HAART has been reported.
The spectrum of HIV-associated pulmonary disease has changed with the introduction of HAART. Current data is limited to determine if asthma and airway hyper-responsiveness are more common among HIV-seropositive individuals treated with HAART.

View all citing articles on Scopus

: Presented in part at the Annual Meeting, American Lung Association, Kansas City MO, May 11, 1986.

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Clinical InvestigationsAbnormal Airway Function in Individuals with the Acquired Immunodeficiency Syndrome

Section snippets

Sample Selection and Testing Procedures

Prevalence of Abnormal Airway Function in AIDS

DISCUSSION

Chest

Chest

Am J Med

Am J Med

Chest

Chest

Pulmonary complications of the acquired immunodeficiency syndrome: a report of a National Heart, Lung and Blood Workshop

N Engl J Med

Acquired immunodeficiency syndrome in infants

N Engl J Med

Clinical Investigations
Abnormal Airway Function in Individuals with the Acquired Immunodeficiency Syndrome