Chest
Volume 123, Issue 6, June 2003, Pages 1977-1982
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Clinical Investigations
HIV
Respiratory Symptoms Among HIV-Seropositive Individualsa

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Study objectives

Recent evidence suggests that chronic or latent viral infection may be an important predisposing factor in the development of COPD among smokers. As such, understanding if HIV-seropositive smokers are at heightened risk for respiratory symptoms may have relevance with regard to COPD pathogenesis. The current study was done to systematically identify the prevalence of respiratory symptoms among an HIV-seropositive population and to identify associated clinical features.

Design and setting

Cross-sectional analysis at an academic medical center.

Participants

Three hundred twenty-seven HIV-seropositive individuals without a history of AIDS-related pulmonary complications. Fifty-two HIV-negative individuals with a similar age and smoking history served as a comparison group.

Measurements

Administration of the American Thoracic Society Division of Lung Diseases respiratory questionnaire, and pulmonary function studies.

Results

Respiratory symptoms including dyspnea (41.6% vs 7.7%), cough (40% vs 25%), and phlegm production (41.9% vs 23.1%) were extremely common in the HIV-group and significantly more common than in the HIV-negative group. Current or prior cigarette smoking was the most important predictor of respiratory symptoms among the HIV-seropositive group. The use of the antiretroviral agent lamivudine was associated with a significant reduction in dyspnea.

Conclusion

HIV-seropositive individuals are at increased risk for the development of respiratory symptoms even prior to the onset of AIDS-related pulmonary complications. This may reflect a heightened susceptibility to the effects of cigarette smoking.

Section snippets

Subjects and Study Protocol

Three hundred twenty-seven HIV-seropositive subjects with no history of AIDS-related pulmonary complications comprised a cohort participating in a longitudinal study evaluating pulmonary physiology, respiratory symptoms, and chest CT. Data included in this report represent baseline data and were collected between 1993 and 1998. All subjects completed the ATS-DLD questionnaire and underwent pulmonary function testing. All subjects provided written consent under an approved protocol of The Ohio

Baseline Demographics and Clinical Variables

Table 2summarizes the demographic data in both groups. As demonstrated in the table, there was no significant difference in age between the two study groups. In addition, the majority of subjects were white and male, and the groups were also similar with respect to sex and race (data not shown). Of note, the BMI, despite being normal (100.3 ± 1.0% of predicted), was significantly lower in the HIV-seropositive group. The prevalence of cigarette smoking was approximately equal in both groups;

Discussion

Over the course of the HIV epidemic, pulmonary complications have been an important source of morbidity and mortality in this patient population. Both infectious and noninfectious complications have been well described.1112However, evidence exists that HIV-infected individuals may acquire unexplained alterations in pulmonary function12and high-resolution chest CT131415independent of or prior to overt pulmonary complications. Our current study examining the results of the ATS-DLD respiratory

Acknowledgment

The authors thank Tina Bees for assistance with manuscript preparation.

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]).

    Supported by National Institutes of Health, National Heart, Lung, and Blood Institute grants RO1 49730 and RO1 53229, and The Ohio State University General Clinical Research Center grant MO1 RR00034.

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