Faster lung function decline in people living with HIV despite adequate treatment: a longitudinal matched cohort study

Rebekka Faber Thudium, Andreas Ronit, Shoaib Afzal, Yunus Çolak, Julie Lyng Forman, Fernando Mendo, Fabian Chen, Vicente Estrada, Nagalingeswaran Kumarasamy, Børge G Nordestgaard, Jens Lundgren, Jørgen Vestbo, Ken M Kunisaki, Susanne Dam Nielsen*, COCOMO, INSIGHT START Pulmonary Substudy and CGPS Study Groups

*Corresponding author for this work


INTRODUCTION: Chronic lung disease is common among people living with HIV (PLWH). We hypothesised that PLWH receiving antiretroviral therapy (ART) have faster lung function decline than matched controls.

METHODS: We performed a prospective matched cohort study by including ART-treated PLWH from the Copenhagen Co-morbidity in HIV Infection Study (n=705) and the INSIGHT Strategic Timing of Antiretroviral Treatment Pulmonary Substudy (n=425) and frequency matched population controls from the Copenhagen General Population Study (n=2895) in a 1:3 ratio. Eligible participants were ≥25 years old and had two spirometry tests separated by at least 2 years of follow-up. Forced expiratory volume in 1 s (FEV1) decline (mL/year) was compared between PLWH and controls using a linear mixed model adjusted for age, sex, ethnicity and smoking status. Effect modification by smoking was investigated in subgroup analyses.

RESULTS: The majority of PLWH were virally suppressed (96.1%). The adjusted mean annual decline in FEV1 was faster in PLWH than in controls with 36.4 (95% CI 33.7 to 39.1) vs 27.9 (95% CI 26.9 to 28.8) mL/year, yielding a difference of 8.5 (95% CI 5.6 to 11.4) mL/year. The association between HIV and FEV1 decline was modified by smoking, with the largest difference in current smokers (difference: 16.8 (95% CI 10.5 to 23.0) mL/year) and the smallest difference in never-smokers (difference: 5.0 (95% CI 0.7 to 9.3) mL/year). FEV1 decline >40 mL/year was more prevalent in PLWH (adjusted OR: 1.98 (95% CI 1.67 to 2.34)).

CONCLUSION: Well-treated PLWH have faster lung function decline than controls and smoking seems to modify this association, suggesting that smoking may lead to more rapid lung function decline in PLWH than in controls.

Original languageEnglish
Issue number6
Pages (from-to)535-542
Number of pages8
Publication statusPublished - Jun 2023


  • Adult
  • Cohort Studies
  • Forced Expiratory Volume
  • HIV Infections/complications
  • Humans
  • Lung
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive


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