Asthma diagnosis and airway bronchodilator response in HIV-infected patients

作者：Gingo Matthew R; Wenzel Sally E; Steele Chad; Kessinger Cathy J; Lucht Lorrie; Lawther Tammi; Busch Michelle; Hillenbrand Maria E; Weinman Renee; Slivka William A; McMahon Deborah K; Zhang Yingze; Sciurba Frank C; Morris Alison^*

来源：Journal of Allergy and Clinical Immunology, 2012, 129(3): 708-U168.

DOI：10.1016/j.jaci.2011.11.015

• HIV
• asthma
• airway obstruction
• allergy

Background: Despite the high prevalence of respiratory symptoms and obstructive lung disease in HIV-infected subjects, the prevalence of bronchodilator reversibility (BDR) and asthma has not been systematically studied during the era of combination antiretroviral therapy (ART).
Objective: We sought to determine the prevalence of asthma diagnosis and related pulmonary function abnormalities in an HIV-infected cohort and to identify potential mechanisms. Methods: We performed a cross-sectional analysis of 223 HIV-infected subjects with data on respiratory symptoms and diagnoses, pulmonary function, sputum cell counts, and asthma-related cytokines and chemokines in serum/sputum.
Results: Doctor-diagnosed asthma was present in 46 (20.6%), and BDR (>= 200 mL and >= 12% increase in FEV1 or forced vital capacity) was present in 20 (9.0%) participants. Pulmonary symptoms and function were worse in those with doctor-diagnosed asthma. Doctor-diagnosed asthma was independently associated with female sex (P = .04), body mass index of greater than 29.6 kg/m(2) (vs < 29.6 kg/m(2), P = .03), history of bacterial or Pneumocystis pneumonia (P = .01), and not currently taking ART (P = .04) and in univariate analysis with parental history of asthma (n = 180, P = .004). High sputum eosinophil percentages (> 2.3% based on the highest decile) were more likely in those with doctor-diagnosed asthma (P = .02) or BDR (P = .02). Doctor-diagnosed asthma tended to be more common with high sputum IL-4 (P = .02) and RANTES (P = .02) levels, whereas BDR was associated with high plasma macrophage inflammatory protein 1 alpha (P = .002) and sputum macrophage inflammatory protein 1 beta (P = .001) levels.
Conclusion: Asthma diagnosis and BDR are prevalent in an HIV-infected outpatient cohort, and associations with family history, obesity, allergic inflammation, prior infection, absence of ART, and increased HIV-stimulated cytokines suggest possible mechanisms of HIV-associated asthma. (J Allergy Clin Immunol 2012; 129: 708-14.)

• 出版日期2012-3