The impact of HAART on the respiratory complications of HIV infection: longitudinal trends in the MACS and WIHS cohorts.

Abstract

OBJECTIVE:

To review the incidence of respiratory conditions and their effect on mortality in HIV-infected and uninfected individuals prior to and during the era of highly active antiretroviral therapy (HAART).

DESIGN:

Two large observational cohorts of HIV-infected and HIV-uninfected men (Multicenter AIDS Cohort Study [MACS]) and women (Women's Interagency HIV Study [WIHS]), followed since 1984 and 1994, respectively.

METHODS:

Adjusted odds or hazards ratios for incident respiratory infections or non-infectious respiratory diagnoses, respectively, in HIV-infected compared to HIV-uninfected individuals in both the pre-HAART (MACS only) and HAART eras; and adjusted Cox proportional hazard ratios for mortality in HIV-infected persons with lung disease during the HAART era.

RESULTS:

Compared to HIV-uninfected participants, HIV-infected individuals had more incident respiratory infections both pre-HAART (MACS, odds ratio [adjusted-OR], 2.4; 95% confidence interval [CI], 2.2-2.7; p<0.001) and after HAART availability (MACS, adjusted-OR, 1.5; 95%CI 1.3-1.7; p<0.001; WIHS adjusted-OR, 2.2; 95%CI 1.8-2.7; p<0.001). Chronic obstructive pulmonary disease was more common in MACS HIV-infected vs. HIV-uninfected participants pre-HAART (hazard ratio [adjusted-HR] 2.9; 95%CI, 1.02-8.4; p = 0.046). After HAART availability, non-infectious lung diseases were not significantly more common in HIV-infected participants in either MACS or WIHS participants. HIV-infected participants in the HAART era with respiratory infections had an increased risk of death compared to those without infections (MACS adjusted-HR, 1.5; 95%CI, 1.3-1.7; p<0.001; WIHS adjusted-HR, 1.9; 95%CI, 1.5-2.4; p<0.001).

CONCLUSION:

HIV infection remained a significant risk for infectious respiratory diseases after the introduction of HAART, and infectious respiratory diseases were associated with an increased risk of mortality.

• Authors: Matthew R Gingo, G K Balasubramani, Lawrence Kingsley, Charles R Rinaldo Jr, Christine B Alden, Roger Detels, Ruth M Greenblatt, Nancy A Hessol, Susan Holman, Laurence Huang, Eric C Kleerup, John Phair, Sarah H Sutton, Eric C Seaberg, Joseph B Margolick, Stephen R Wisniewski, Alison Morris
• Journal: PloS one (PLoS One) Vol. 8 Issue 3 Pg. e58812 ( 2013) ISSN: 1932-6203 [Electronic] United States
• PMID: 23554932 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)

Topics

• Adult
• Antiretroviral Therapy, Highly Active
• Female
• HIV Infections (complications, drug therapy, mortality)
• Humans
• Incidence
• Longitudinal Studies
• Lung Diseases (epidemiology, etiology)
• Male
• Respiration Disorders (epidemiology, etiology)
• Young Adult