Pulmonary-function tests in HIV-infected patients without aids

Abstract

To determine the prevalence, incidence, and types of lung diseases that occur in association with HIV infection, 1,353 subjects, including HIV-seropositive homosexual men, injection drug users, female sexual partners of HIV-positive men, and HIV-seronegative control subjects from the first two transmission categories were evaluated prospectively in a multicenter study. Patients with AIDS at the time of initial evaluation were excluded. One thousand two-hundred ninety-four subjects who had no AIDS-defining diagnosis within 3 mo of enrollment had measurements of FVC, FEV(1) and D-LCO at the time of enrollment. As a group, all subjects had mean values of FVC and FEV(1) close to 100% predicted. Those with CD4 counts below 200/mm(3) had slightly reduced D-LCO compared with the others. Subjects with a history of HIV-associated symptoms (thrush, weight loss, herpes tester) also had a reduced D-LCO compared with those without symptoms. Injection drug users had reduced FVC, FEV(1) and D-LCO compared with homosexual men and female sexual partners of HIV-infected men, with D-LCO more substantially reduced. Part of the reduction in D-LCO in drug users was attributable to factors other than HIV infection, especially cigarette smoking and race. Using predicted values that take cigarette smoking into account, the prevalence of abnormality in D-LCO was higher among injection drug users (33.3%) than among homosexual men (11.2%) and female sexual partners (12.7%). These results show that advanced HIV infection, characterized by CD4 count < 200/mm(3) or HIV-associated symptoms, and factors unrelated to HIV infection, including race, cigarette smoking, and injection drug use, are all associated with reductions in D-LCO measurements