Asthma diagnosis and airway bronchodilator response in HIV-infected patients

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 FEV 1 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 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 1α ( P  = .002) and sputum macrophage inflammatory protein 1β ( 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.