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Am. J. Respir. Crit. Care Med., Volume 162, Number 2, August 2000, 612-616

Permanent Declines in Pulmonary Function Following Pneumonia in Human Immunodeficiency Virus-Infected Persons

ALISON M. MORRIS, LAURENCE HUANG, PETER BACCHETTI, JOAN TURNER, PHILIP C. HOPEWELL, JEANNE M. WALLACE, PAUL A. KVALE, MARK J. ROSEN, JEFFREY GLASSROTH, LEE B. REICHMAN, JOHN D. STANSELL, and The Pulmonary Complications of HIV Infection Study Group

San Francisco General Hospital and Division of Pulmonary and Critical Care Medicine, Department of Medicine, and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan; Pulmonary Department, Mount Sinai Medical Center, New York, New York; Department of Medicine, Northwestern University, Chicago, Illinois; and Department of Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey

Human immunodeficiency virus (HIV)-associated respiratory infections, most notably Pneumocystis carinii pneumonia (PCP), but also bacterial pneumonia (BP), result in reductions in lung function that have been studied mainly during the course of acute infection. Whether HIV-associated pneumonias also cause permanent changes in pulmonary function is unknown. In this study we investigated the long-term effects of PCP and BP on pulmonary function in a cohort of HIV-infected persons. One thousand, one hundred forty-nine HIV-infected persons were followed in a prospective, observational cohort study at six centers in the United States. Study participants had pulmonary function testing performed at regular preset intervals. PCP and BP diagnoses were verified with defined criteria. Longitudinal multivariate analysis was used to model pulmonary function in terms of demographic data and occurrence of PCP or BP. We found that PCP or BP was associated with permanent decreases in FEV1, FVC, FEV1/FVC, and the diffusing capacity of carbon monoxide. Neither infection resulted in statistically significant changes in TLC. We conclude that PCP and BP result in expiratory airflow reductions that persist after the acute infection resolves. The clinical implications of these changes are unknown, but they may contribute to prolonged respiratory complaints in HIV-infected patients who have had pneumonia.




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