PULMONARY-FUNCTION TESTS IN HIV-INFECTED PATIENTS WITHOUT AIDS

To determine the prevalence, incidence, and types of lung diseases tha t occur in association with HIV infection, 1,353 subjects, including H IV-seropositive homosexual men, injection drug users, female sexual pa rtners of HIV-positive men, and HIV-seronegative control subjects from the first two transmission categories were evaluated prospectively in a multicenter study. Patients with AIDS at the time of initial evalua tion were excluded. One thousand two-hundred ninety-four subjects who had no AIDS-defining diagnosis within 3 mo of enrollment had measureme nts of FVC, FEV(1) and D-LCO at the time of enrollment. As a group, al l subjects had mean values of FVC and FEV(1) close to 100% predicted. Those with CD4 counts below 200/mm(3) had slightly reduced D-LCO compa red with the others. Subjects with a history of HIV-associated symptom s (thrush, weight loss, herpes tester) also had a reduced D-LCO compar ed with those without symptoms. Injection drug users had reduced FVC, FEV(1) and D-LCO compared with homosexual men and female sexual partne rs of HIV-infected men, with D-LCO more substantially reduced. Part of the reduction in D-LCO in drug users was attributable to factors othe r than HIV infection, especially cigarette smoking and race. Using pre dicted values that take cigarette smoking into account, the prevalence of abnormality in D-LCO was higher among injection drug users (33.3%) than among homosexual men (11.2%) and female sexual partners (12.7%). These results show that advanced HIV infection, characterized by CD4 count < 200/mm(3) or HIV-associated symptoms, and factors unrelated to HIV infection, including race, cigarette smoking, and injection drug use, are all associated with reductions in D-LCO measurements.