Women with HIV in Uganda have higher risk for chronic lung disease

Women in Uganda with HIV may be more susceptible to chronic lung diseases, according to results of a longitudinal cohort study published in Annals of the American Thoracic Society.

“To our knowledge, this is the first demonstration of a gender-specific difference in HIV-associated FEV₁ decline,” Jenna McNeill, MD, attending physician in the division of pulmonary and critical care medicine at Massachusetts General Hospital and Harvard Medical School, and colleagues wrote.

Researchers gender-matched 145 adults living with HIV aged at least 40 years who were on antiretroviral therapy for at least 3 years and were cared for at Mbarara Regional Referral Hospital’s HIV clinic in southwestern Uganda. A total of 133 participants without HIV were recruited from their homes based on age and gender. From 2015 to 2018, all participants completed annual spirometry.

At study completion, 278 participants (median age, 52 years; 47% women) completed 613 spirometry tests during a median of two visits and 1.5 years of follow-up. Overall, 52% of participants were people living with HIV.

FEV₁ declined by –24.4 mL per year (P = .07) and FVC declined by –34.5 mL per year (P = .02). Declines in FEV₁ and FVC did not differ by HIV serostatus.

Women with HIV experienced a more accelerated FEV₁ decline compared with women who did not have HIV (additional decline of –46.3 mL per year; P = .04) in gender-stratified models. Researchers observed no HIV-associated difference in FEV₁ decline among men and no difference in FVC decline among women or men.

According to the researchers, potential hypotheses to explain these findings might include:

• Women have a greater HIV infection immune response, but chronic inflammation among people living with HIV is associated with lung dysfunction.
• In this cohort, women with HIV had higher systemic inflammation, which was associated with lower FEV₁.
• Women in sub-Saharan Africa have higher household air pollution exposure, and this can cause acute and chronic lung dysfunction.

“Future work is needed to explore the potentially causative role of immune regulation, air pollution and/or sex hormones on lung function decline among people living with HIV,” the researchers wrote.