In a new study, researchers observed a relationship between impaired lung function and coronary artery disease linked with increased mortality in adults with HIV.
“Coronary artery disease is among the top ve causes of death in persons with HIV infection, and its prevalence is increasing as these individuals live longer with modern antiretroviral therapy,” DivayChandra, MD, MSc, assistant professor of medicine in the department of pulmonary, allergy and critical care medicine at the University of Pittsburgh, and colleagues wrote in the Annals of the American Thoracic Society. “Nonetheless, understanding of the determinants and risk factors for [coronary artery disease] in HIV remains incomplete.”
Chandra and colleagues pooled data on spirometry, diffusing capacity of the lung for carbon monoxide (DLCO), emphysema, coronary artery calcium (CAC), mortality, cause of death and biomarkers among individuals with HIV (n = 177) and without HIV (n = 57).
Men and women with and without HIV (standard deviation age, 49.5 ± 10.2 years; 82.1% men; 67.5% ever smokers) were recruited from outpatient clinics and were free of acute respiratory symptoms within the 4 weeks before study entry.
Results showed that among those with HIV, lower DLCO appeared independently associated with greater CAC (OR = 1.43 per 10% lower DLCO; 95% CI, 1.14-1.81).
During a median follow-up of 5.9 years, mortality was 21.6% in those with low DLCOand presence of CAC (HR = 6.3; 95% CI, 1.3-29.7), 12.5% in those with normal DLCO and presence of CAC (HR = 3.3; 95% CI, 0.6-17.4), 10.4% in those with low DLCO and no CAC (HR = 2.6; 95% CI, 0.5-13.3) and 3.8% in those with normal DLCOand no CAC, the researchers wrote.
Moreover, endothelin-1 — a circulating biomarker of endothelial dysfunction — was associated with lower DLCO and greater CAC in those with HIV.
Investigators validated the results in the Multicenter AIDS Cohort Study (MACS) cohort — including homosexual and bisexual men older than 18 years and without AIDS at enrollment across four metropolitan centers in the United States — and found that the results from the University of Pittsburgh cohort were reproducible in 144 individuals enrolled in MACS.
“Pulmonary vascular and coronary vascular injury should be further investigated as potentially related processes that may be associated with markers of endothelial dysfunction and higher mortality in HIV,” the researchers wrote.
By Jennifer Southall