PURPOSE: Studies conducted prior to the widespread use of Highly Active Anti-Retroviral Therapy (HAART) demonstrated an increased risk for the development of chronic respiratory symptoms among HIV-seropositive individuals. Since HAART has dramatically decreased HIV-related pulmonary complications and has likely decreased chronic inflammatory changes in the lung, it is possible that the prevalence of respiratory symptoms among HIV-seropositive individuals has decreased in the HAART era. The purpose of the present study is to compare the prevalence of respiratory symptoms among HIV-seropositive subjects in the pre- and post-HAART eras.
METHODS: 168 HIV-seropositive individuals were prospectively studied (3/2006-3/2007) with a modified American Thoracic Society Division of Lung Diseases respiratory questionnaire. Data were compared to results obtained from an HIV-seropositive cohort (n = 326) studied predominantly in the pre-HAART era (1993-1998). The prevalence of respiratory symptoms including cough, wheeze, dyspnea, and phlegm production were compared between the two groups. Additionally, clinical factors including CD4 count, age, sex, body mass index, intravenous drug use and smoking history were examined to determine any correlation with respiratory symptoms.
RESULTS: The mean (±SE) age (43.6 ± 3.4 vs 34.7 ± 0.4), pack year smoking history (19.1 ± 1.6 vs. 12.2 ± 0.9) and CD4 count (475.3 ± 22.7 vs 370.7 ± 14.7) of the current cohort were all greater than that of the pre-HAART cohort. The prevalence of all respiratory symptoms was much higher in the current cohort than the original one: chronic cough –57.7% vs. 24.8%; p < 0.001; chronic phlegm –40.4% vs. 26.2%; p < 0.015; wheeze –48.7% vs. 18.4%; p < 0.001; dyspnea –38.2% vs. 19.4%; p < 0.001). Pack year smoking history was the only variable consistently associated with respiratory symptoms in the current cohort.
CONCLUSION: The prevalence of respiratory symptoms among HIV-seropositive individuals has dramatically increased in the HAART era. This is likely due to the aging of the population and the cumulative effects of cigarette smoke.
CLINICAL IMPLICATIONS: Increased efforts are needed to promote smoking cessation in this population.
DISCLOSURE: Carmen Rosario, None.