Asthma and related atopic disorders in outpatients attending an urban HIV clinic

Abstract

Background: Drug hypersensitivity and pruritic cutaneous disorders are common in human immunodeficiency virus (HIV)-infected patients. Systematic cross-sectional studies, detailing the pattern of atopic disease, however, have not been performed in patients with HIV infection.

Objective: To analyze the relationships between atopic disease and factors relating to lifestyle, environment, gender, genetics, and HIV disease-associated immune cell depletion.

Methods: CD4 cell counts and interview data were recorded in a survey of 136 adult patients attending a community hospital-based HIV outpatient clinic. The reported presence of various atopic and related conditions (including asthma, hay fever, otitis, sinusitis, and dermatitis) were analyzed for prevalence and associations with CD4 cell depletion, family atopy, and other factors using logistic regression.

Results: Seventeen percent and 15% of patients claimed to have asthma and hay fever, respectively. Eleven percent claimed chronic nasal symptoms without known hay fever. A recent CD4 count > or = 200 cells/dL was significantly associated with current asthma (P = .01) and this association remained after adjusting for other significant factors. The mean recent log CD4 count for patients with current asthma was significantly higher than other patients (5.63 +/- .73 versus 4.92 +/- 1.38, P = .001). There was no association between rhinitis and CD4 cell depletion. Histories of recent sinusitis (24%) and ear infections (16%) were common, and were significantly associated with current hay fever +/- chronic nasal symptoms (P < .05). Chronic pruritic rashes or eczema were reported in 29% and were more frequent in those with CD4 counts < 200/dL. Family histories of either asthma or hay fever were significantly associated with several condition including hay fever +/- chronic nasal symptoms, otitis, drug allergy, chronic pruritic rashes or eczema, and asthma.

Conclusions: Although atopic disorders in the setting of HIV infection appear to have some clinical associations similar to that reported for the general population, asthma appears to have a predilection towards less severe CD4 cell depletion. The potential role of chronic rhinitis +/- family atopy as risk factors for sinusitis and otitis may be important because treatment of selected individuals with rhinitis may potentially decrease some paranasal disease-related morbidity in HIV infection.