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. 2023 Sep 1;37(11):1683-1692.
doi: 10.1097/QAD.0000000000003626. Epub 2023 Jun 19.

Sex modifies the risk of HIV-associated obstructive lung disease in Ugandans postpneumonia

Rebecca A Abelman  1 , Jessica Fitzpatrick  1 , Josephine Zawedde  2 , Ingvar Sanyu  2 , Patrick Byanyima  2 , Sylvia Kaswabuli  2 , Emmanuel Musisi  3 , Jenny Hsieh  4 , Kendall Gardner  1 , Michelle Zhang  1 , Katerina L Byanova  4 , Abdul Sessolo  2 , Peter W Hunt  5 , Rejani Lalitha  6 , J Lucian Davis  7   8 , Kristina Crothers  9 , William Worodria  6   10 , Laurence Huang  1   4
Affiliations

Sex modifies the risk of HIV-associated obstructive lung disease in Ugandans postpneumonia

Rebecca A Abelman et al. AIDS. .

Abstract

Objectives: Spirometric abnormalities are frequent, and obstructive lung disease (OLD) is a common comorbidity among people with HIV (PWH). HIV increases the risk of many comorbidities to a greater degree in women than in men. Few studies have evaluated whether sex modifies the HIV-associated risk of OLD.

Design and methods: To evaluate the associations between sex and HIV with abnormal lung function, women and men with and without HIV underwent spirometric testing after completing therapy for pneumonia, including tuberculosis (TB), in Kampala, Uganda. OLD was defined as a postbronchodilator forced expiratory volume in the first second to forced vital capacity (FEV 1 /FVC) ratio less than 0.70. Associations between sex, HIV, and lung function were evaluated using multivariable regression models including sex-by-HIV interaction terms after adjusting for age, BMI, smoking status, and TB status.

Results: Among 348 participants, 147 (42%) were women and 135 (39%) were HIV-positive. Sixteen (11%) women and 23 men (11%) had OLD. The HIV-sex interaction was significant for obstructive lung disease ( P = 0.04). In the adjusted stratified analysis, women with HIV had 3.44 (95% CI 1.11-12.0; P = 0.04) increased odds of having OLD compared with men with HIV. Women without HIV did not have increased odds of having OLD compared with men without HIV.

Conclusion: HIV appears to increase the risk of OLD to a greater degree in women than in men in an urban Ugandan setting. The mechanistic explanation for this interaction by sex remains unclear and warrants further study.

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Conflict of interest statement

Disclosures: The authors have no financial disclosures.

Figures

Figure 1.
Figure 1.
Flow Diagram of Participant Inclusion in the Analysis
Figure 2:
Figure 2:. Odds of obstructive lung disease and spirometric restriction by sex, stratified by HIV status
* Adjusted for age, smoking status, BMI, and TB status
See this image and copyright information in PMC

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Supplementary concepts