Respiratory disease trends in the pulmonary complications of HIV infection study cohort

Jeanne Marie Wallace*, Nellie I. Hansen, Lisa LaVange, Jeffrey Glassroth, Ben L. Browdy, Mark J. Rosen, Paul A. Kvale, Bonita T. Mangura, Lee B. Reichman, Philip C. Hopewell, John Stansell, Joan Turner, Cynthia Merrifield, Dennis Osmond, Melinda Mossar, Robert Hirschtick, Lori Meiselman, Kim K. Manghisi, Roslyn F. Schneider, Sandra BarnesBarbara Le Maire, Barbara Richer, Virgilio Clemente, Janet Au, Anne Coulson, James Sayre, Norman Markowitz, Louis D. Saravolatz, Christine Johnson, Joanne Huitsing, Annmarie Krystotorski, W. Kenneth Poole, A. Vijaya Rao, Kim Clayton, Matt Jordan, Jim Thompson, David Myers, Judith Katzin, William Fulkerson, Yu Lou, Tim Wilcosky, Anthony R. Kalica, Janet Wittes, Dean Follman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

175 Scopus citations

Abstract

We examined trends in the incidence of specific respiratory disorders in a multicenter cohort with progressive human immunodeficiency virus (HIV) disease during a 5-yr period. Individuals with a wide range of HIV disease severity belonging to three transmission categories were evaluated at regular intervals and for episodic respiratory symptoms using standard diagnostic algorithms. Yearly incidence rates of respiratory diagnoses were assessed in the cohort as a whole and according to CD4 count or HIV transmission category. The most frequent respiratory disorders were upper respiratory tract infections, but the incidence of lower respiratory tract infections increased as CD4 counts declined. Specific lower respiratory infections followed distinctive patterns according to study-entry CD4 count and transmission category. Acute bronchitis was the predominant lower respiratory infection of cohort members with entry CD4 counts ≤ 200 cells/mm3. In cohort members with entry CD4 counts of 200 to 499 cells/mm3, the incidence of bacterial and Pneumocystis carinii pneumonia each increased an average of 40% per year. In members with entry CD4 counts < 200 cells/mm3, acute bronchitis, bacterial pneumonia, and P. carinii pneumonia occurred at high rates without discernible time trends, despite chemoprophylaxis in more than 80% after Year 1, and the rate of other pulmonary opportunistic infections increased over time. Each year, injecting drug users had a higher incidence of bacterial pneumonia than did homosexual men. The yearly rate of tuberculosis was < 3 episodes/100 person-yr in each entry CD4 and HIV- transmission group. We conclude that the time trends of HIV-associated respiratory disorders are determined by HIV disease stage and influenced by transmission category. Whereas acute bronchitis is prevalent during all stages of HIV infection, incidence rates of bacterial pneumonia and P. carinii pneumonia rise continuously during progression to advanced disease. In advanced disease, the incidence of acute bronchitis, bacterial pneumonia and P. carinii pneumonia is high despite widespread chemoprophylaxis.

Original languageEnglish (US)
Pages (from-to)72-80
Number of pages9
JournalAmerican journal of respiratory and critical care medicine
Volume155
Issue number1
DOIs
StatePublished - 1997

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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