A pilot study of the effects of losartan vs. placebo on pneumoproteins in HIV: A secondary analysis of a randomized, double blind, study.

Human immunodeficiency virus (HIV) is an independent risk factor for lung disease, including chronic obstructive pulmonary disease (COPD) and emphysema. Angiotensin receptor blockers may be beneficial in COPD and emphysema through pathways that have been implicated in HIV-related lung disease. We performed a randomized comparison of the effects of losartan vs placebo on the plasma concentrations of the pneumoproteins surfactant protein D (SPD) and club cell secretory protein (CCSP) in people living with HIV (PLWH). 108 PLWH were included (52 assigned to losartan and 56 assigned to placebo). We found no difference in the change from baseline in log(2) concentrations of CCSP or SPD over 1 year of follow-up. For SPD, we found a strong interaction by CD4+ counts, where those with CD4+ counts > 350 cells/mm3 treated with losartan had more reduction (improvement) in SPD concentration than those treated with placebo (p-value for interaction < 0.001). In conclusion, we did not find a beneficial effect of losartan on pneumoprotein concentrations in PLWH, but PLWH with higher CD4+ counts may have improvement in SPD when treated with losartan.