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 HIV and Coverage of the
th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2009)
September 12-15, 2009, San Francisco, CA
 The material posted on HIV and about the 49th ICAAC is not approved by the American Society for Microbiology
Effective Antiretroviral Therapy Leads to Improved Lung Function in People with HIV

HIV positive people treated with effective combination antiretroviral therapy (ART) experience improvement in lung function over time, but the beneficial effects may be cancelled out by tobacco smoking, according to a poster presented at the 49th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2009) last month in San Francisco.

By Liz Highleyman

Danish researchers conducted a study to investigate long-term changes in pulmonary function among HIV positive patients who received optimal treatment.

Pulmonary function tests (PFTs) are a group of breathing tests that help doctors see how well your lungs are working.
lung function

Though HIV-related pulmonary mortality has decreased since the advent of ART, the investigators noted as background, "pulmonary morbidity is still a considerable target of improvement for modern HIV management and research."

This prospective study included 63 consecutive HIV patients seen at an outpatient clinic in Copenhagen between October 2000 and March 2007. The mean follow-up period was 4.5 years (range 3.8 to 5.7 years). About half were smokers and half were non-smokers (33 vs 30, respectively).

Most participants (87%) were men and the mean age was 43 years. Patients overall had well-controlled HIV disease; 89% were on ART, 85% had HIV RNA < 100 copies/mL, and the mean CD4 count was 520 cells/mm3.

During 2 examinations (the first in 2000-2001, the second in 2007-2008), the researchers measured forced expiratory volume in one second (FEV1), functional vital capacity (FVC), total lung capacity (TLC), peak flow (PEF), residual volume (RV), and carbon monoxide diffusion capacity divided by alveolar volume (DLco/VA). To adjust for increased age at follow-up, percentages of these values were reported. FEV1 as a percentage of FVC (FEV1%FVC) was also calculated.


On the first exam, FEV1%, FVC%, TLC%, PEF%, and RV% were similar for smokers and non-smokers.
DLco/VA% and FEV1/FVC, however, were reduced in smokers compared with non-smokers.
  Over the follow-up period, FEV1% and PEF% remained stable in both groups.
FVC% increased among non-smokers (100.1% to 104.5%; P = 0.005) and among smokers (99.5% to 103.1%; P = 0.023).
TLC% also decreased among both non-smokers (102.8% to 92.3%; P < 0.001) and smokers (101.0% to 93.0%; P < 0.001).
FEV1%FCV, too, decreased among non-smokers (83.0% to 78.3%; P < 0.001) and smokers (76.5% to 71.8%; P < 0.001).
DLCO/VA% increased among both non-smokers 80.7% to 100.4%; P < 0.001) and smokers (63.8% to 79.3%; P < 0.001).
RV%, however, decreased among non-smokers (109.9% to 98.3%; P = 0.004), but increased among smokers (108.8% to 122.8%; P = 0.046).

In both smoking and non-smoking HIV patients, the investigators noted, abnormal lung function parameters were present at the first exam. On a group basis, both non-smokers and smokers had decreased diffusion capacity and lung function parameters "somewhat compatible with signs of early obstructive lung disease," they stated.

The researchers explained that blood-gas exchange in the lungs normalized in non-smokers on ART over the follow-up period, while improvement among smokers was more modest (reaching approximately the starting point of the non-smokers). Residual volume normalized in non-smokers, but worsened further among smokers.

"Modern HIV treatment seems to reverse the negative effects of HIV on the lungs" without adding other lung function impairments, for example related to ART toxicity or IRIS, the investigators noted.

"This study suggests that modern HIV management overall is beneficial for the lung status of HIV patients and that some HIV induced changed even seem to be reversed over time when HIV is well-managed," they concluded.

However, they added, "these beneficial effects of HIV treatment are to a large extent overshadowed by the negative effects of smoking in the HIV patients who use tobacco."

Rigshospitalet, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark; Hvidovre Hospital, Copenhagen, Denmark.


US Kristoffersen, A Lebech, J Gerstoft, and others. Changes of Lung Function in an Optimally Treated HIV Population: A 4.5 Year Follow Up Study. 49th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2009). San Francisco. September 12-15, 2009. Abstract H-1561.

























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