부산대학교 도서관

Objectives An isolated reduction in the diffusing capacity for carbon monoxide (DLco; iso[down-pointing arrow]DLco) is one of the most common pulmonary function test (PFT) abnormalities in people living with HIV (PWH), but its clinical implications are incompletely understood. In this study, we explored whether iso[down-pointing arrow]DLco in PWH is associated with a greater respiratory symptom burden. Study design Cross-sectional analysis Methods We used ATS/ERS compliant PFTs from PWH with normal spirometry (post-bronchodilator FEV1/FVC [greater than or equal to]0.7; FEV1, FVC [greater than or equal to]80% predicted) from the I AM OLD cohort in San Francisco, CA and Seattle, WA, grouped by DLco categorized as normal (DLco [greater than or equal to]lower limit of normal, LLN), mild iso[down-pointing arrow]DLco (LLN >DLco >60% predicted), and moderate-severe iso[down-pointing arrow]DLco (DLco [less than or equal to]60% predicted). We performed multivariable analyses to test for associations between DLco and validated symptom-severity and quality of life questionnaires, including the modified Medical Research Council dyspnea scale (mMRC), the COPD Assessment Test (CAT), and St. George's Respiratory Questionnaire (SGRQ), as well as between DLco and individual CAT symptoms. Results Mild iso[down-pointing arrow]DLco was associated only with a significantly higher SGRQ score. Moderate-severe iso[down-pointing arrow]DLco was associated with significantly higher odds of mMRC [greater than or equal to]2 and significantly higher CAT and SGRQ scores. PWH with moderate-severe iso[down-pointing arrow]DLco had increased odds of breathlessness, decreased activity, lower confidence leaving home, and less energy. Conclusions Iso[down-pointing arrow]DLco is associated with worse respiratory symptom scores, and this association becomes stronger with worsening DLco, suggesting that impaired gas exchange alone has a significant negative impact on the quality of life in PWH. Additional studies are ongoing to understand the etiology of this finding and design appropriate interventions.
Author(s): Katerina L. Byanova 1,*, Jessica Fitzpatrick 2, Amanda K. Jan 2, Maggie McGing 2, Marlena Hartman-Filson 2, Carly K. Farr 3, Michelle Zhang 2, Kendall Gardner 2, Jake Branchini [...]