Abstract
Background
Preserved ratio impaired spirometry (PRISm), defined as a normal ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (≥0.70) with low FEV1 (<80% predicted), has been associated with increased mortality in the general population. Female sex has been associated with increased odds of PRISm in people without HIV. People with HIV (PWH) are at increased risk for lung function abnormalities, but whether HIV modifies the effect of sex on PRISm development is largely unknown.
Methods
Adults with and without HIV underwent baseline followed by serial spirometry after completing therapy for pneumonia, predominantly tuberculosis (TB), in Kampala, Uganda. Using generalized estimating equations adjusted for age, body mass index, smoking, biomass fuel exposure, HIV, and TB status, we compared individuals with PRISm with those with normal spirometry. These models were stratified by HIV status.
Results
Of 339 baseline participants, 153 (45%) were women; 129 (38%) had HIV, of whom 53% were women. Overall, 105/339 participants (31%) had PRISm at baseline. HIV was associated with lower odds of PRISm (adjusted odds ratio [aOR], 0.38; 95% CI, 0.21–0.68; P = .001). Female sex trended toward increased odds of PRISm among all participants (aOR, 1.65; 95% CI, 0.99–2.75; P = .052). The association between female sex and PRISm tended to be stronger among PWH (aOR, 3.16; 95% CI, 1.14–8.76; P = .03) than among those without HIV (aOR, 1.34; 95% CI, 0.73–2.45; P = .34); this study was underpowered to detect an HIV–sex interaction of this magnitude (P = .30).
Conclusions
Among Ugandan adults who recovered from pneumonia, female sex was associated with increased odds and HIV with decreased odds of PRISm, suggesting independent sex and HIV effects on PRISm pathogenesis.
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Details
1 Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco , San Francisco, California , USA
2 Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco , San Francisco, California , USA
3 Infectious Diseases Research Collaboration , Kampala , Uganda
4 Division of Infection and Global Health, School of Medicine, University of St. Andrews , St. Andrews , UK
5 Department of Anesthesia and Critical Care, University of California San Francisco , San Francisco, California , USA
6 Division of Experimental Medicine, Department of Medicine, University of California San Francisco , San Francisco, California , USA
7 Division of Pulmonary Medicine, Department of Medicine, Makerere College of Health Sciences , Kampala , Uganda
8 Department of Epidemiology of Microbial Diseases, Yale School of Public Health , New Haven, Connecticut , USA
9 Division of Pulmonary, Critical Care and Sleep, Department of Medicine, Veterans Affairs (VA) Puget Sound Health Care System and University of Washington , Seattle, Washington , USA