Clinical and Immunological Markers of Pulmonary Impairment among People with HIV(PWH) in India

Background
Despite anti-retroviral therapy, chronic lung diseases remain an important source of morbidity and mortality in people with HIV (PWH). We sought to identify clinical and immunological markers of pulmonary impairment among PWH in India.

Methods
210 adult PWH receiving antiretroviral therapy (ART) were prospectively evaluated for three years. Plasma concentrations of interleukin (IL)-6, IL-10, TNF-a, D-dimer, C-reactive protein, soluble (s)CD14 and sCD163 were measured at enrolment. We used multi-variable linear and logistic regression to measure the association of baseline and time-varying clinical and immunological variables with spirometry defined chronic obstructive pulmonary disease (COPD), restrictive spirometry pattern (RSP), preserved ratio impaired spirometry (PRISm), forced expiratory volume in 1st second (FEV1) and forced vital capacity (FVC) during the third year of follow-up.

Results
After adjusting confounders, females were 7 times more likely to have RSP (95%CI 2.81 to 17.62, p < 0.001) and 22 times more likely to have PRISm (95%CI 7.42 to 69.92, p < 0.001) compared to men. Higher IL-6 concentrations were associated with lower FEV1 z-scores (β=-0.14 per log-higher, 95%CI -0.29 to 0.008, p = 0.06) and higher odds of COPD (aOR = 2.66 per log-higher, 95%CI 1.16 to 6.09, p = 0.02). Higher D-dimer concentrations were associated with lower FVC z-scores (β=-0.40 per log-higher, 95%CI -0.78 to -0.01, p = 0.04). Conversely, higher IL-10 concentrations were associated with lower odds of PRISm (aOR = 0.76 per log-higher, 95%CI 0.59 to 0.99, p = 0.04).

Conclusions
Female sex, higher concentrations of IL-6 and D-dimer, and lower concentrations of IL-10 were associated with pulmonary impairment in adult PWH receiving ART in India.