Permanent declines in pulmonary function following pneumonia in human immunodeficiency virus-infected persons

Human immunodeficiency virus (HIV)-associated respiratory infections, most notably Pneumocystis carinii pneumonia (PCP), but also bacterial pneumonia (BP), result in reductions in lung function that have been studied mainly d uring the course of acute infection. Whether HIV-associated pneumonias also cause permanent changes in pulmonary function is unknown. In this study we investigated the long-term effects of PCP and BP on pulmonary function in a cohort of HIV-infected persons. One thousand, one hundred forty-nine HIV- infected persons were followed in a prospective, observational cohort study at six centers in the United States. Study participants had pulmonary func tion testing performed at regular preset intervals. PCP and BP diagnoses we re verified with defined criteria. Longitudinal multivariate analysis was u sed to model pulmonary function in terms of demographic data and occurrence of PCP or BP. We found that PCP or BP was associated with permanent decrea ses in FEV1, FVC, FEV1/FVC, and the diffusing capacity of carbon monoxide. Neither infection resulted in statistically significant changes in TLC. We conclude that PCP and BP result in expiratory airflow reductions that persi st after the acute infection resolves. The clinical implications of these c hanges are unknown, but they may contribute to prolonged respiratory compla ints in HIV-infected patients who have had pneumonia.