Study: Men with HIV at greater risk of abnormal lung function

VA is the single-largest provider of HIV care in the United States, with just over 31,000 Veterans with the virus in care last year. Now, a new study finds a greater risk for impaired lung function among men with HIV, compared to men without HIV.

The findings appeared in the journal AIDS in July 2020.

The researchers found that compared to men without HIV, HIV-positive men were more likely to have abnormal lung function, based on low diffusing capacity of the lungs. Diffusing capacity measures the ability of the lungs to transfer oxygen into red blood cells, which is one of the most important lung functions. Low diffusing capacity has been linked to worse quality of life, worse exercise capacity, and a higher risk of respiratory disease and early death.

`A complex relationship’

The reasons for the difference in diffusing capacity are unclear, the researchers note. “But our analyses suggest a complex relationship between lung function abnormalities, HIV infection, HIV treatment, cigarette smoking, and immune function,” they write.

Dr. Ken Kunisaki, a pulmonologist at the Minneapolis VA Health Care System, led the study. He was not surprised by the conclusion, given that smaller studies have suggested the same problem. However, “Our large study helped us confirm that this is something we need to pursue further,” he notes.

The researchers carried out the study between April 1, 2017, and March 31, 2018. Nearly 1,100 men enrolled in the Multicenter AIDS Cohort Study (MACS), an ongoing study of HIV infection in gay and bisexual men in four U.S. cities—Baltimore, Chicago, Los Angeles, and Pittsburgh. Kunisaki and his team tested 591 HIV-positive and 476 HIV-negative men for lung function.

More research needed to understand HIV

HIV (human immunodeficiency virus), the virus that causes AIDS, attacks cells that help the body fight infection, making a person more vulnerable to other infections and diseases. It is spread by contact with certain bodily fluids of a person with HIV, most commonly during unprotected sex or through the sharing of intravenous needles.

Today, medications allow people with HIV to live long lives, and those on effective HIV treatment don’t transmit the virus to others. That is why getting tested and treated for HIV early is very important. But there’s no way to permanently eliminate the virus once a person gets it. Studies have shown the virus can lead to health problems like heart disease, brain dysfunction, erratic sleep patterns, and lung disease.

“It stays in certain cells in the body,” says Kunisaki, who is also an associate professor at the University of Minnesota. “This low-level virus could lead to inflammation of tissue and blood vessels directly in the lungs. The virus might also change how the body responds to other routine infections like bacterial pneumonia. We are learning more all the time, but we still have a lot more research to do before we understand this better.”

Study included a series of notable strengths

Studies have suggested that HIV-positive men may be at higher risk for lung diseases, such as COPD (chronic obstructive pulmonary disease), which blocks airflow from the lungs. Its symptoms include breathing difficulty, coughing, mucus production, and wheezing. But those studies were often done at one clinic or hospital, they lacked HIV-negative controls, or they assessed lung function only with spirometry. The latter is an instrument for measuring the volume of air the lungs can hold and how quickly the lungs empty the air.

In comparison, Kunisaki and his team tested differences in spirometry and single-breath diffusing capacity in men with and without HIV. Other notable strengths in his study included its multicenter design and relatively large sample size.

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