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 FEV 1 and FVC, while airflow limitation was defined by the lower limit of normal (LLN) of FEV 1 /FVC and by FEV 1 /FVC<0.7 with FEV 1 predicted <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 FEV 1 and 395 mL (344–447, P<0.0001) lower FVC, and 100 cells/mm 3 lower CD4 nadir was associated with 30 mL (7–52, P<0.01) lower FEV 1 and 51 mL (24–78, P<0.001) lower FVC. Conclusion HIV is a risk factor for concurrently decreased FEV 1 and FVC. This excess risk is not explained by smoking or socioeconomic status and may be mediated by prior immunodeficiency. Trial registration number NCT02382822.