PULMONARY-FUNCTION IN HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION - A PROSPECTIVE 18-MONTH STUDY OF SERIAL LUNG-FUNCTION IN 474 PATIENTS

To investigate the development of a reduced DL(CO) in patients with HIV-related disease, we studied 474 HIV-seropositive patients and performed serial lung function measurements over 18 months. The mean values of DL(CO) st presentation were lower in patients with mom advanced HIV disease compared with asymptomatic HIV-seropositive patients (DL(CO) 88% of predicted). When compared with the DL(CO) in asymptomatic HIV-seropositive patients, the DL(CO) had reduced values in patients with persistent generalized lymphadenopathy (PGL) (82% of predicted, p < 0.05), acquired deficiency syndrome-related complex (ARC) (73% predicted, p < 0.001), nonpulmonary Kaposi's sarcoma (KS) (72% of predicted, p < 0.001), nonpulmonary complications of AIDS excluding KS (73% of predicted, p < 0.001), pulmonary KS (63% of predicted, p < 0.001), pulmonary mycobacterial infection (68% of predicted, p < 0.05), pyogenic infection (70%, p < 0.05), scute Pneumocystis carinii pneumonia (PCP; 49%, p < 0.001), and following recovery from PCP (71%, p < 0.001). Serial lung function measurements over 18 months revealed no change in DL(CO) within any patient group, and in particular there wes no tendency for a gradual decline. Clinical deterioration due to the development of PCP was associated with a reduction in DL(CO). Conversely, in patients recovering from PCP, there was a partial improvement in DL(CO) over 3 months. Zidovudine (AZT) use did not affect DL(CO) within any diagnostic group or the recovery in DL(CO) following PCP. However, cigarette smoking was associated with further reductions in DL(CO) In all patient groups and with an impaired recovery of DL(CO) following scute PCP. This study confirmed that DL(CO) was reduced in patients with pulmonary and nonpulmonary HIV-related complications. There was no evidence of an insidious decline in DL(CO) or of a beneficial effect of zidovudine.