Pulmonary Function in Human Immunodeficiency Virus Infection: A Prospective 18-Month Study of Serial Lung Function in 474 Patients

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Abstract
To Investigate the development of a reduced DlCO in patients with HIV-related disease, we studied 474 HIV-seropositive patients and performed serial lung function measurements over 18 months. The mean values of DlCO at presentation were lower in patients with more advanced HIV disease compared with asymptomatic HIV-seropositive patients (DlCO 88% of predicted). When compared with the DlCO in asymptomatic HIV-seropositlve patients, the DlCO had reduced values in patients with persistent generalized lymphadenopathy (PGL) (82% of predicted, p < 0.05), acquired deficiency syndrome-related complex (ARC) (73% predicted, p < 0.001), nonpulmonary Kaposi's sarcoma (KS) (72% of predicted, p < 0.001), nonpulmonary complications of AIDS excluding KS (73% of predicted, p < 0.001), pulmonary KS (63% of predicted, p < 0.001), pulmonary mycobacterial infection (68% of predicted, p < 0.05), pyogenic infection (70%, p < 0.05), acute Pneumocystis carinii pneumonia (PCP; 49%, p < 0.001), and following recovery from PCP (71%, p < 0.001). Serial lung function measurements over 18 months revealed no change in DlCO within any patient group, and in particular there was no tendency for a gradual decline. Clinical deterioration due to the development of PCP was associated with a reduction In DlCO. Conversely, in patients recovering from PCP, there was a partial improvement in DlCO over 3 months. Zidovudine (AZT) use did not affect DlCO within any diagnostic group or the recovery in DlCO following PCP. However, cigarette smoking was associated with further reductions in DlCO in all patient groups and with an impaired recovery of DlCO following acute PCP. This study confirmed that DlCO was reduced in patients with pulmonary and nonpulmonary HIV-related complications. There was no evidence of an insidious decline in DlCO or of a beneficial effect of zidovudine.