Faster lung function decline in people living with HIV despite adequate treatment: A longitudinal matched cohort study

Rebekka Faber Thudium; Andreas Ronit; Shoaib Afzal; Yunus Çolak; Julie Lyng Forman; Fernando Mendo; Fabian Chen; Vicente Estrada; Nagalingeswaran Kumarasamy; Børge G. Nordestgaard; Jens Lundgren; Jørgen Vestbo; Ken M. Kunisaki; Susanne Dam Nielsen

doi:10.1136/thorax-2022-218910

Faster lung function decline in people living with HIV despite adequate treatment: A longitudinal matched cohort study

Rebekka Faber Thudium, Andreas Ronit, Shoaib Afzal, Yunus Çolak, Julie Lyng Forman, Fernando Mendo, Fabian Chen, Vicente Estrada, Nagalingeswaran Kumarasamy, Børge G. Nordestgaard, Jens Lundgren, Jørgen Vestbo, Ken M. Kunisaki, Susanne Dam Nielsen

Medicine - Veteran's Administration Medical Center

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

Introduction Chronic lung disease is common among people living with HIV (PLWH). We hypothesised that PLWH receiving antiretroviral therapy (ART) have faster lung function decline than matched controls. Methods We performed a prospective matched cohort study by including ART-treated PLWH from the Copenhagen Co-morbidity in HIV Infection Study (n=705) and the INSIGHT Strategic Timing of Antiretroviral Treatment Pulmonary Substudy (n=425) and frequency matched population controls from the Copenhagen General Population Study (n=2895) in a 1:3 ratio. Eligible participants were ≥25 years old and had two spirometry tests separated by at least 2 years of follow-up. Forced expiratory volume in 1 s (FEV 1) decline (mL/year) was compared between PLWH and controls using a linear mixed model adjusted for age, sex, ethnicity and smoking status. Effect modification by smoking was investigated in subgroup analyses. Results The majority of PLWH were virally suppressed (96.1%). The adjusted mean annual decline in FEV 1 was faster in PLWH than in controls with 36.4 (95% CI 33.7 to 39.1) vs 27.9 (95% CI 26.9 to 28.8) mL/year, yielding a difference of 8.5 (95% CI 5.6 to 11.4) mL/year. The association between HIV and FEV 1 decline was modified by smoking, with the largest difference in current smokers (difference: 16.8 (95% CI 10.5 to 23.0) mL/year) and the smallest difference in never-smokers (difference: 5.0 (95% CI 0.7 to 9.3) mL/year). FEV 1 decline >40 mL/year was more prevalent in PLWH (adjusted OR: 1.98 (95% CI 1.67 to 2.34)). Conclusion Well-treated PLWH have faster lung function decline than controls and smoking seems to modify this association, suggesting that smoking may lead to more rapid lung function decline in PLWH than in controls.

Original language	English (US)
Pages (from-to)	535-542
Number of pages	8
Journal	Thorax
Volume	78
Issue number	6
DOIs	https://doi.org/10.1136/thorax-2022-218910
State	Published - Jun 1 2023

Bibliographical note

Funding Information:
The COCOMO study was supported by Rigshospitalet Research Council, Gilead Sciences and the Novo Nordisk Foundation. The START Pulmonary Substudy was supported by the National Heart Lung and Blood Institute (R01 HL096453); the parent START trial was primarily supported by the National Institute of Allergy and Infectious Diseases Division of AIDS (UM1 AI068641 and UM AI120197) with additional support from the German Ministry of Education and Research, the European AIDS Treatment Network (NEAT), the Australian National Health and Medical Research Council, and the UK Medical Research Council and National Institute for Health Research. This material is also the result of work supported with resources and the use of facilities at the Minneapolis Veterans Affairs Medical Center, Minneapolis/USA. JV is supported by the NIHR Manchester Biomedical Research Centre.

Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords

COPD epidemiology
Immunodeficiency
Respiratory Measurement
Tobacco and the lung
Viral infection

PubMed: MeSH publication types

Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Thudium, R. F., Ronit, A., Afzal, S., Çolak, Y., Forman, J. L., Mendo, F., Chen, F., Estrada, V., Kumarasamy, N., Nordestgaard, B. G., Lundgren, J., Vestbo, J., Kunisaki, K. M., & Nielsen, S. D. (2023). Faster lung function decline in people living with HIV despite adequate treatment: A longitudinal matched cohort study. Thorax, 78(6), 535-542. https://doi.org/10.1136/thorax-2022-218910

Thudium, RF, Ronit, A, Afzal, S, Çolak, Y, Forman, JL, Mendo, F, Chen, F, Estrada, V, Kumarasamy, N, Nordestgaard, BG, Lundgren, J, Vestbo, J, Kunisaki, KM & Nielsen, SD 2023, 'Faster lung function decline in people living with HIV despite adequate treatment: A longitudinal matched cohort study', Thorax, vol. 78, no. 6, pp. 535-542. https://doi.org/10.1136/thorax-2022-218910

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abstract = "Introduction Chronic lung disease is common among people living with HIV (PLWH). We hypothesised that PLWH receiving antiretroviral therapy (ART) have faster lung function decline than matched controls. Methods We performed a prospective matched cohort study by including ART-treated PLWH from the Copenhagen Co-morbidity in HIV Infection Study (n=705) and the INSIGHT Strategic Timing of Antiretroviral Treatment Pulmonary Substudy (n=425) and frequency matched population controls from the Copenhagen General Population Study (n=2895) in a 1:3 ratio. Eligible participants were ≥25 years old and had two spirometry tests separated by at least 2 years of follow-up. Forced expiratory volume in 1 s (FEV 1) decline (mL/year) was compared between PLWH and controls using a linear mixed model adjusted for age, sex, ethnicity and smoking status. Effect modification by smoking was investigated in subgroup analyses. Results The majority of PLWH were virally suppressed (96.1%). The adjusted mean annual decline in FEV 1 was faster in PLWH than in controls with 36.4 (95% CI 33.7 to 39.1) vs 27.9 (95% CI 26.9 to 28.8) mL/year, yielding a difference of 8.5 (95% CI 5.6 to 11.4) mL/year. The association between HIV and FEV 1 decline was modified by smoking, with the largest difference in current smokers (difference: 16.8 (95% CI 10.5 to 23.0) mL/year) and the smallest difference in never-smokers (difference: 5.0 (95% CI 0.7 to 9.3) mL/year). FEV 1 decline >40 mL/year was more prevalent in PLWH (adjusted OR: 1.98 (95% CI 1.67 to 2.34)). Conclusion Well-treated PLWH have faster lung function decline than controls and smoking seems to modify this association, suggesting that smoking may lead to more rapid lung function decline in PLWH than in controls.",

keywords = "COPD epidemiology, Immunodeficiency, Respiratory Measurement, Tobacco and the lung, Viral infection",

author = "Thudium, {Rebekka Faber} and Andreas Ronit and Shoaib Afzal and Yunus {\c C}olak and Forman, {Julie Lyng} and Fernando Mendo and Fabian Chen and Vicente Estrada and Nagalingeswaran Kumarasamy and Nordestgaard, {B{\o}rge G.} and Jens Lundgren and J{\o}rgen Vestbo and Kunisaki, {Ken M.} and Nielsen, {Susanne Dam}",

note = "Funding Information: The COCOMO study was supported by Rigshospitalet Research Council, Gilead Sciences and the Novo Nordisk Foundation. The START Pulmonary Substudy was supported by the National Heart Lung and Blood Institute (R01 HL096453); the parent START trial was primarily supported by the National Institute of Allergy and Infectious Diseases Division of AIDS (UM1 AI068641 and UM AI120197) with additional support from the German Ministry of Education and Research, the European AIDS Treatment Network (NEAT), the Australian National Health and Medical Research Council, and the UK Medical Research Council and National Institute for Health Research. This material is also the result of work supported with resources and the use of facilities at the Minneapolis Veterans Affairs Medical Center, Minneapolis/USA. JV is supported by the NIHR Manchester Biomedical Research Centre. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ",

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doi = "10.1136/thorax-2022-218910",

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T1 - Faster lung function decline in people living with HIV despite adequate treatment

T2 - A longitudinal matched cohort study

AU - Thudium, Rebekka Faber

AU - Ronit, Andreas

AU - Afzal, Shoaib

AU - Çolak, Yunus

AU - Forman, Julie Lyng

AU - Mendo, Fernando

AU - Chen, Fabian

AU - Estrada, Vicente

AU - Kumarasamy, Nagalingeswaran

AU - Nordestgaard, Børge G.

AU - Lundgren, Jens

AU - Vestbo, Jørgen

AU - Kunisaki, Ken M.

AU - Nielsen, Susanne Dam

N1 - Funding Information: The COCOMO study was supported by Rigshospitalet Research Council, Gilead Sciences and the Novo Nordisk Foundation. The START Pulmonary Substudy was supported by the National Heart Lung and Blood Institute (R01 HL096453); the parent START trial was primarily supported by the National Institute of Allergy and Infectious Diseases Division of AIDS (UM1 AI068641 and UM AI120197) with additional support from the German Ministry of Education and Research, the European AIDS Treatment Network (NEAT), the Australian National Health and Medical Research Council, and the UK Medical Research Council and National Institute for Health Research. This material is also the result of work supported with resources and the use of facilities at the Minneapolis Veterans Affairs Medical Center, Minneapolis/USA. JV is supported by the NIHR Manchester Biomedical Research Centre. Publisher Copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2023/6/1

Y1 - 2023/6/1

N2 - Introduction Chronic lung disease is common among people living with HIV (PLWH). We hypothesised that PLWH receiving antiretroviral therapy (ART) have faster lung function decline than matched controls. Methods We performed a prospective matched cohort study by including ART-treated PLWH from the Copenhagen Co-morbidity in HIV Infection Study (n=705) and the INSIGHT Strategic Timing of Antiretroviral Treatment Pulmonary Substudy (n=425) and frequency matched population controls from the Copenhagen General Population Study (n=2895) in a 1:3 ratio. Eligible participants were ≥25 years old and had two spirometry tests separated by at least 2 years of follow-up. Forced expiratory volume in 1 s (FEV 1) decline (mL/year) was compared between PLWH and controls using a linear mixed model adjusted for age, sex, ethnicity and smoking status. Effect modification by smoking was investigated in subgroup analyses. Results The majority of PLWH were virally suppressed (96.1%). The adjusted mean annual decline in FEV 1 was faster in PLWH than in controls with 36.4 (95% CI 33.7 to 39.1) vs 27.9 (95% CI 26.9 to 28.8) mL/year, yielding a difference of 8.5 (95% CI 5.6 to 11.4) mL/year. The association between HIV and FEV 1 decline was modified by smoking, with the largest difference in current smokers (difference: 16.8 (95% CI 10.5 to 23.0) mL/year) and the smallest difference in never-smokers (difference: 5.0 (95% CI 0.7 to 9.3) mL/year). FEV 1 decline >40 mL/year was more prevalent in PLWH (adjusted OR: 1.98 (95% CI 1.67 to 2.34)). Conclusion Well-treated PLWH have faster lung function decline than controls and smoking seems to modify this association, suggesting that smoking may lead to more rapid lung function decline in PLWH than in controls.

AB - Introduction Chronic lung disease is common among people living with HIV (PLWH). We hypothesised that PLWH receiving antiretroviral therapy (ART) have faster lung function decline than matched controls. Methods We performed a prospective matched cohort study by including ART-treated PLWH from the Copenhagen Co-morbidity in HIV Infection Study (n=705) and the INSIGHT Strategic Timing of Antiretroviral Treatment Pulmonary Substudy (n=425) and frequency matched population controls from the Copenhagen General Population Study (n=2895) in a 1:3 ratio. Eligible participants were ≥25 years old and had two spirometry tests separated by at least 2 years of follow-up. Forced expiratory volume in 1 s (FEV 1) decline (mL/year) was compared between PLWH and controls using a linear mixed model adjusted for age, sex, ethnicity and smoking status. Effect modification by smoking was investigated in subgroup analyses. Results The majority of PLWH were virally suppressed (96.1%). The adjusted mean annual decline in FEV 1 was faster in PLWH than in controls with 36.4 (95% CI 33.7 to 39.1) vs 27.9 (95% CI 26.9 to 28.8) mL/year, yielding a difference of 8.5 (95% CI 5.6 to 11.4) mL/year. The association between HIV and FEV 1 decline was modified by smoking, with the largest difference in current smokers (difference: 16.8 (95% CI 10.5 to 23.0) mL/year) and the smallest difference in never-smokers (difference: 5.0 (95% CI 0.7 to 9.3) mL/year). FEV 1 decline >40 mL/year was more prevalent in PLWH (adjusted OR: 1.98 (95% CI 1.67 to 2.34)). Conclusion Well-treated PLWH have faster lung function decline than controls and smoking seems to modify this association, suggesting that smoking may lead to more rapid lung function decline in PLWH than in controls.

KW - COPD epidemiology

KW - Immunodeficiency

KW - Respiratory Measurement

KW - Tobacco and the lung

KW - Viral infection

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Faster lung function decline in people living with HIV despite adequate treatment: A longitudinal matched cohort study

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

Access

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