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Original research
Faster lung function decline in people living with HIV despite adequate treatment: a longitudinal matched cohort study
  1. Rebekka Faber Thudium1,
  2. Andreas Ronit2,
  3. Shoaib Afzal3,
  4. Yunus Çolak3,4,5,
  5. Julie Lyng Forman6,
  6. Fernando Mendo7,
  7. Fabian Chen8,
  8. Vicente Estrada9,
  9. Nagalingeswaran Kumarasamy10,
  10. Børge G Nordestgaard3,5,
  11. Jens Lundgren1,5,11,
  12. Jørgen Vestbo12,
  13. Ken M Kunisaki13,14,
  14. Susanne Dam Nielsen1,5
  15. for the COCOMO, INSIGHT START Pulmonary Substudy and CGPS Study Groups
  1. 1 Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  2. 2 Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre Hospital, Hvidovre, Denmark
  3. 3 Department of Clinical Biochemistry and The Copenhagen General Population Study, Herlev and Gentofte University Hospital, Copenhagen, Denmark
  4. 4 Department of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
  5. 5 Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  6. 6 Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
  7. 7 Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
  8. 8 Royal Berkshire Hospital, Reading, UK
  9. 9 Hospital Clinico San Carlos-IdiSSC, Universidad Complutense, Madrid, Spain
  10. 10 Voluntary Health Services, VHS Infectious Diseases Medical Centre, Chennai, Tamilnadu, India
  11. 11 CHIP, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  12. 12 Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
  13. 13 Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
  14. 14 University of Minnesota, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Susanne Dam Nielsen, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Rigshospitalet, Copenhagen, 2100, Denmark; sdn{at}


Introduction Chronic lung disease is common among people living with HIV (PLWH). We hypothesised that PLWH receiving antiretroviral therapy (ART) have faster lung function decline than matched controls.

Methods We performed a prospective matched cohort study by including ART-treated PLWH from the Copenhagen Co-morbidity in HIV Infection Study (n=705) and the INSIGHT Strategic Timing of Antiretroviral Treatment Pulmonary Substudy (n=425) and frequency matched population controls from the Copenhagen General Population Study (n=2895) in a 1:3 ratio. Eligible participants were ≥25 years old and had two spirometry tests separated by at least 2 years of follow-up. Forced expiratory volume in 1 s (FEV1) decline (mL/year) was compared between PLWH and controls using a linear mixed model adjusted for age, sex, ethnicity and smoking status. Effect modification by smoking was investigated in subgroup analyses.

Results The majority of PLWH were virally suppressed (96.1%). The adjusted mean annual decline in FEV1 was faster in PLWH than in controls with 36.4 (95% CI 33.7 to 39.1) vs 27.9 (95% CI 26.9 to 28.8) mL/year, yielding a difference of 8.5 (95% CI 5.6 to 11.4) mL/year. The association between HIV and FEV1 decline was modified by smoking, with the largest difference in current smokers (difference: 16.8 (95% CI 10.5 to 23.0) mL/year) and the smallest difference in never-smokers (difference: 5.0 (95% CI 0.7 to 9.3) mL/year). FEV1 decline >40 mL/year was more prevalent in PLWH (adjusted OR: 1.98 (95% CI 1.67 to 2.34)).

Conclusion Well-treated PLWH have faster lung function decline than controls and smoking seems to modify this association, suggesting that smoking may lead to more rapid lung function decline in PLWH than in controls.

  • COPD epidemiology
  • Immunodeficiency
  • Respiratory Measurement
  • Viral infection
  • Tobacco and the lung

Data availability statement

Due to restrictions from the Danish Data Protection agency no data are available.

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Data availability statement

Due to restrictions from the Danish Data Protection agency no data are available.

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  • KK and SDN contributed equally.

  • Contributors RFT was responsible for concept, data collection, statistical analysis and interpretation and drafted the manuscript. AR, SA, YÇ and BNG were responsible for concept, data collection and edited the manuscript. JLF supervised the statistical analyses and interpretation of data and edited the manuscript. FM, FC, VE, NK, JL and JV were responsible for concept and edited the manuscript. KMK and SDN were responsible for concept, data collection, supervision and take full responsibility for the overall content of the study as guarantors.

  • Funding The COCOMO study was supported by Rigshospitalet Research Council, Gilead Sciences and the Novo Nordisk Foundation. The START Pulmonary Substudy was supported by the National Heart Lung and Blood Institute (R01 HL096453); the parent START trial was primarily supported by the National Institute of Allergy and Infectious Diseases Division of AIDS (UM1 AI068641 and UM AI120197) with additional support from the German Ministry of Education and Research, the European AIDS Treatment Network (NEAT), the Australian National Health and Medical Research Council, and the UK Medical Research Council and National Institute for Health Research. This material is also the result of work supported with resources and the use of facilities at the Minneapolis Veterans Affairs Medical Center, Minneapolis/USA. JV is supported by the NIHR Manchester Biomedical Research Centre.

  • Competing interests RFT: None. AR: None. SA: None. YÇ: reports personal fees from Boehringer Ingelheim, AstraZeneca, and Sanofi Genzyme. JLF: None. FM: None. FC: None. VE: None. NK: None. BGN: None. JL: None. JV: reports personal fees from AstraZeneca, Boehringer-Ingelheim, Chiesi, GSK and Novartis and an institutional grant from Boehringer-Ingelheim. KMK: Research grants from US National Institutes of Health, Department of Defense, and Department of Veterans Affairs; Consulting fees from Allergan; Data Safety and Monitoring Board fees from Nuvaira. SDN: unrestricted research grants from Novo Nordisk Foundation and Rigshospitalet Research Council and an unrestricted research grant from Gilead. Advisory board activity for Gilead and GSK/ViiV.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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