Is HIV infection a risk factor for asthma?
Published Online: December 19, 2011
As treatment has improved and more people are living longer with HIV infection, chronic diseases have become a common problem in persons with HIV. Prior to effective antiretroviral treatment, airway hyperresponsiveness was more frequent in HIV-infected individuals, but the prevalence of airway hyperresponsiveness has not been systematically evaluated during the era of effective antiretroviral therapy. It is possible that asthma is actually more common in the current era as there have been recent reports that HIV-infected children on effective antiretroviral therapy are now more commonly treated for asthma and adults using antiretroviral therapy have evidence of worse airflow obstruction.
In an article in The Journal of Allergy and Clinical Immunology (JACI), Gingo et al describe a cross-sectional analysis of the prevalence of a prior diagnosis of asthma (doctor-diagnosed asthma) and bronchodilator reversibility (improvement in airflow after treatment with an albuterol inhaler) in 223 HIV-infected individuals. They investigated factors associated with doctor-diagnosed asthma and bronchodilator reversibility, including demographic data, smoking and drug use history, body mass index, medication use and medical history, sputum eosinophil counts, and sputum and serum inflammatory cytokine levels.
In this HIV-infected group, 20.6% had been previously told by their doctors they had asthma and 9% had bronchodilator reversibility documented by spirometry. Doctor-diagnosed asthma was associated with female sex, obesity, a history of bacterial or Pneumocystis pneumonia, and not currently taking antiretroviral medication as well as a parental history of asthma. Doctor-diagnosed asthma and bronchodilator reversibility were associated with high sputum eosinophils as well as high levels of inflammatory cytokines in the sputum and plasma.
This study is the first in the period of effective antiretroviral therapy to determine the prevalence of doctor-diagnosed asthma and bronchodilator reversibility. Associations with family history, obesity, allergic inflammation, prior infection, not using antiretroviral therapy, and elevated cytokines suggest possible mechanisms of HIV-associated asthma.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.