Journal Article

The Impact of HAART on the Respiratory Complications of HIV Infection: Longitudinal Trends in the MACS and WIHS Cohorts

Rinaldo, Charles R., Detels, Roger, Sutton, Sarah H., Phair, John, Morris, Alison, Kingsley, Lawrence, Balasubramani, G. K., Huang, Laurence, Kleerup, Eric C., Alden, Christine B., Holman, Susan, Wisniewski, Stephen R., Greenblatt, Ruth M., Seaberg, Eric C., Hessol, Nancy A., Margolick, Joseph B., Gingo, Matthew R.

2013

Overview

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). 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. 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. 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). 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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Adult / AIDS / Antiretroviral agents / Antiretroviral drugs / Antiretroviral Therapy, Highly Active / Biology / Chronic obstructive lung disease / Chronic obstructive pulmonary disease / Complications / Confidence intervals / Female / Hazards / Health aspects / Health hazards / Health risk assessment / Health risks / Highly active antiretroviral therapy / HIV / HIV infections / HIV Infections - complications / HIV Infections - drug therapy / HIV Infections - mortality / Human immunodeficiency virus / Humans / Incidence / Infections / Infectious diseases / Longitudinal Studies / Lung diseases / Lung Diseases - epidemiology / Lung Diseases - etiology / Male / Medical diagnosis / Medicine / Mortality / Mortality risk / Obstructive lung disease / Respiration Disorders - epidemiology / Respiration Disorders - etiology / Respiratory diseases / Risk / Tuberculosis / Young Adult