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Rigshospitalet - a part of Copenhagen University Hospital
E-pub ahead of print

Fraction of exhaled nitric oxide levels are elevated in people living with HIV compared to uninfected controls suggesting increased eosinophilic airway inflammation

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OBJECTIVE: Increased risk of asthma and chronic obstructive pulmonary disease has been reported in people living with HIV (PLWH). Fraction of exhaled Nitric Oxide (FeNO) is a marker of eosinophilic airway inflammation. We assessed FeNO levels in PLWH and matched uninfected controls and investigated whether HIV status is independently associated with elevated FeNO.

METHODS: FeNO was quantified by NIOX Vero® and pulmonary function was assessed by spirometry in 432 PLWH from the Copenhagen Comorbidity in HIV Infection (COCOMO) Study and in 1618 age- and sex-matched uninfected controls from the Copenhagen General Population Study. Elevated FeNO was defined as ≥ 25 ppb. Associations between FeNO and HIV status were adjusted for known potential confounders.

RESULTS: Mean age ± standard deviation (SD) of PLWH was 50.7 ± (11.1) years and 97.4% received combination antiretroviral therapy. PLWH had higher FeNO than uninfected controls (median (IQR)) 17.0 (11.0-26.0) versus 13.0 (9.0-19.0), p<0.001. Also, PLWH had a higher prevalence of elevated FeNO than uninfected controls (27.5% versus 12.3%, p<0.001), (odds ratio (OR): 2.71 [95%CI: 2.09-3.51], p<0.001). This association remained after adjusting for age, sex, height, smoking status, use of airway medication, blood eosinophils and IgE (adjusted OR (aOR): 3.56 [95%CI: 2.51-5.04], p<0.001). Elevated FeNO was associated with an increased risk of self-reported asthma (aOR: 2.65 [95%CI: 1.66-4.24], p<0.001) but not with airflow limitation (FEV1/FVC<lower limit of normal) (aOR: 1.07 [95%CI: 0.71-1.62], p=0.745).

CONCLUSION: HIV status was independently associated with elevated FeNO suggesting increased eosinophilic airway inflammation. The potential impact on chronic lung disease pathogenesis needs further investigation.

Original languageEnglish
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Publication statusE-pub ahead of print - 4 Jan 2020

ID: 58903180