SESSION TITLE: Pulmonary Manifestations of Systemic Disease Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM
PURPOSE: To look for an association between both viral load and CD4 cell count and Pulmonary Function Tests (PFTs) in patients infected with HIV.
METHODS: Design: Retrospective analysis. Setting: Academic, Community hospital HIV-AIDS clinic and PFT laboratory. Subjects: Patients infected with HIV, over the age of 18 who have had PFTs performed within a year of their CD4 and viral load testing. Demographic data, PFT data, CD4 counts, viral load levels, hemoglobin and smoking status were obtained. Patients were analyzed in 2 groups based on CD4 cell count (CD4<200 cells/mm3 and CD4>200 cells/mm3) and two groups based on viral load (VL<75 copies/ml and VL >75 copies/ml).
RESULTS: Out of 932 patients being followed at a HIV clinic, 108 had PFTs performed. Fifty six percent were male. The mean age was 53.4 years. The population was 48% Hispanic, 32% African American, 19% Caucasian and 1% Asian. PFTs in patients with high VL (> 75 copies/ml) compared to low VL (<75 copies/ml) were associated with a significantly decreased diffusing capacity (DLCO) (61% vs 70%; p=0.04) and significantly decreased total lung capacity (TLC) (77% vs 89%; p= 0.04). FEV1/FVC was significantly higher in those with a CD4 count <200 cells/mm3 (77% vs 70%; p<0.01), despite the significantly higher number of smokers in this group (52% vs 22%, p=<0.01). There was no significant association between CD4 count and DLCO or TLC.
CONCLUSIONS: The DLCO and TLC are decreased significantly in HIV patients with high viral load. Our data would indicate parenchymal involvement in these patients, which correlates significantly with viral load, but not with the CD4 count. This could explain the crucial role played by the virus itself in the pathogenesis of pulmonary disease in HIV.
CLINICAL IMPLICATIONS: Patients with HIV with inadequate suppression of viral load may be at a higher risk of pulmonary interstitial disease and pulmonary vascular disease. We recommend assessment of DLCO in addition to spirometry in these patients. Abormal findings could be studied further using CT imaging, pathology findings abd radionucleotide uptake studies.
DISCLOSURE: The following authors have nothing to disclose: Navitha Ramesh, Marjan Islam, Jason Filopei, Kartik Ramakrishna, Mary Harris, Albert Miller
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