Sara C Auld1, Hardy Kornfeld2, Pholo Maenetje3, Mandla Mlotshwa3, William Chase4, Mboyo di-Tamba Vangu5, Drew A Torigian4, Robert S Wallis3, Gavin Churchyard3,6, Gregory P Bisson4,7. 1. Departments of Medicine and Epidemiology, School of Medicine and Rollins School of Public Health, Emory University, Atlanta, GA, USA. sauld@emory.edu. 2. Department of Medicine, University of Massachusetts Medical School, Worcester, USA. 3. The Aurum Institute, Johannesburg, South Africa. 4. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. 5. Department of Nuclear Medicine, CM Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa. 6. School of Public Health, University of Witwatersrand, Johannesburg, South Africa. 7. Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Abstract
BACKGROUND: While tuberculosis is considered a risk factor for chronic obstructive pulmonary disease, a restrictive pattern of pulmonary impairment may actually be more common among tuberculosis survivors. We aimed to determine the nature of pulmonary impairment before and after treatment among people with HIV and tuberculosis and identify risk factors for long-term impairment. METHODS: In this prospective cohort study conducted in South Africa, we enrolled adults newly diagnosed with HIV and tuberculosis who were initiating antiretroviral therapy and tuberculosis treatment. We measured lung function and symptoms at baseline, 6, and 12 months. We compared participants with and without pulmonary impairment and constructed logistic regression models to identify characteristics associated with pulmonary impairment. RESULTS: Among 134 participants with a median CD4 count of 110 cells/μl, 112 (83%) completed baseline spirometry at which time 32 (29%) had restriction, 13 (12%) had obstruction, and 9 (7%) had a mixed pattern. Lung function was dynamic over time and 30 (33%) participants had impaired lung function at 12 months. Baseline restriction was associated with greater symptoms and with long-term pulmonary impairment (adjusted odds ratio 5.44, 95% confidence interval 1.16-25.45), while baseline obstruction was not (adjusted odds ratio 1.95, 95% confidence interval 0.28-13.78). CONCLUSIONS: In this cohort of people with HIV and tuberculosis, restriction was the most common, symptomatic, and persistent pattern of pulmonary impairment. These data can help to raise awareness among clinicians about the heterogeneity of post-tuberculosis pulmonary impairment, and highlight the need for further research into mediators of lung injury in this vulnerable population.
BACKGROUND: While tuberculosis is considered a risk factor for chronic obstructive pulmonary disease, a restrictive pattern of pulmonary impairment may actually be more common among tuberculosis survivors. We aimed to determine the nature of pulmonary impairment before and after treatment among people with HIV and tuberculosis and identify risk factors for long-term impairment. METHODS: In this prospective cohort study conducted in South Africa, we enrolled adults newly diagnosed with HIV and tuberculosis who were initiating antiretroviral therapy and tuberculosis treatment. We measured lung function and symptoms at baseline, 6, and 12 months. We compared participants with and without pulmonary impairment and constructed logistic regression models to identify characteristics associated with pulmonary impairment. RESULTS: Among 134 participants with a median CD4 count of 110 cells/μl, 112 (83%) completed baseline spirometry at which time 32 (29%) had restriction, 13 (12%) had obstruction, and 9 (7%) had a mixed pattern. Lung function was dynamic over time and 30 (33%) participants had impaired lung function at 12 months. Baseline restriction was associated with greater symptoms and with long-term pulmonary impairment (adjusted odds ratio 5.44, 95% confidence interval 1.16-25.45), while baseline obstruction was not (adjusted odds ratio 1.95, 95% confidence interval 0.28-13.78). CONCLUSIONS: In this cohort of people with HIV and tuberculosis, restriction was the most common, symptomatic, and persistent pattern of pulmonary impairment. These data can help to raise awareness among clinicians about the heterogeneity of post-tuberculosis pulmonary impairment, and highlight the need for further research into mediators of lung injury in this vulnerable population.
Entities:
Keywords:
HIV; Pulmonary disease; Respiratory function tests; Tuberculosis
Authors: Dave Singh; Alvar Agusti; Antonio Anzueto; Peter J Barnes; Jean Bourbeau; Bartolome R Celli; Gerard J Criner; Peter Frith; David M G Halpin; Meilan Han; M Victorina López Varela; Fernando Martinez; Maria Montes de Oca; Alberto Papi; Ian D Pavord; Nicolas Roche; Donald D Sin; Robert Stockley; Jørgen Vestbo; Jadwiga A Wedzicha; Claus Vogelmeier Journal: Eur Respir J Date: 2019-05-18 Impact factor: 16.671
Authors: Zoe Daniil; Panagiota Kitsanta; George Kapotsis; Maria Mathioudaki; Androniki Kollintza; Marilena Karatza; Joseph Milic-Emili; Charis Roussos; Spyros A Papiris Journal: Respir Res Date: 2005-07-24
Authors: Graeme Meintjes; Stephen D Lawn; Fabio Scano; Gary Maartens; Martyn A French; William Worodria; Julian H Elliott; David Murdoch; Robert J Wilkinson; Catherine Seyler; Laurence John; Maarten Schim van der Loeff; Peter Reiss; Lut Lynen; Edward N Janoff; Charles Gilks; Robert Colebunders Journal: Lancet Infect Dis Date: 2008-08 Impact factor: 25.071