Background: 

Chronic respiratory disease represents an important comorbidity for persons living with HIV (PLWH). HIV itself is associated with greater impairment in lung function. We aimed to determine the association between declining lung function and both quality of life (QOL) and health care utilization for PLWH.

Methods: 

Using longitudinal data from the Study of HIV Infection in the Etiology of Lung Disease 2009–2017, we studied the association between changes in lung function and both QOL and acute care events (emergency department visit or hospitalization). The Medical Outcomes Studies-HIV Questionnaire provided QOL domains. Multivariable regression models were performed with generalized estimating equations accounting for 1499 participants, 485 with HIV, contributing 10,825 spirometry visits.

Results: 

Among PLWH, decreased FEV₁ was associated with worse physical health for those with higher viral load [β: −1.66, 95% confidence interval (CI): −3.11 to −0.39] compared to those with viral suppression (β: −0.58, 95% CI: −1.06 to −0.162), even in those without airflow obstruction. Lower FEV₁ was also associated with increased odds of both emergency department (odds ratio: 1.21, 95% CI: 1.09 to 1.34) and inpatient (odds ratio: 1.26, 95% CI: 1.12 to 1.42) hospitalizations for PLWH. Lung function was not associated with increased odds of acute care events for HIV-uninfected participants.

Conclusions: 

FEV₁ declines represent an independent predictor of QOL and acute care events among PLWH. Although the generalizability of these results may be limited, because of the high-risk population included, findings suggest that care for PLWH should involve monitoring FEV₁ over time, especially in those with poor virologic control, with emphasis on the development and implementation of interventions to mitigate lung function decline.

中文翻译：

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肺功能与高危队列中 HIV 相关生活质量和医疗保健利用的关联。

背景： 

慢性呼吸道疾病是艾滋病病毒感染者 (PLWH) 的一种重要合并症。HIV 本身与肺功能的更大损害有关。我们的目的是确定肺功能下降与 PLWH 的生活质量 (QOL) 和医疗保健利用之间的关联。

方法： 

使用 2009-2017 年肺部疾病病因学中 HIV 感染研究的纵向数据，我们研究了肺功能变化与 QOL 和急性护理事件（急诊科就诊或住院）之间的关联。医疗结果研究-HIV 问卷提供了 QOL 域。多变量回归模型使用广义估计方程进行，其中 1499 名参与者，485 名 HIV 感染者，贡献了 10,825 次肺活量测定访问。

结果： 

在 PLWH 中，与病毒抑制的患者相比（β：-0.58 _， 95% CI：-1.06 至 -0.162），即使在没有气流阻塞的情况下也是如此。较低的 FEV ₁还与 PLWH 急诊（优势比：1.21，95% CI：1.09 至 1.34）和住院（优势比：1.26，95% CI：1.12 至 1.42）住院的几率增加有关。对于未感染 HIV 的参与者，肺功能与急性护理事件发生几率的增加无关。

结论： 

FEV ₁下降代表 PLWH 中 QOL 和急性护理事件的独立预测因子。尽管这些结果的普遍性可能有限，但由于包含高危人群，研究结果表明，对 PLWH 的护理应包括随时间监测 FEV ₁ ，尤其是在病毒学控制不佳的患者中，重点是干预措施的制定和实施以减轻肺功能衰退。