Greater ambient air pollution exposure is associated with worse respiratory symptoms in men and women with HIV and chronic lung disease: a cohort study.

BACKGROUND: COPD and impairment in diffusing capacity for carbon monoxide (DLCO) are common comorbidities in people with HIV (PWH). HIV may increase susceptibility to inhaled toxins including air pollution. In PWH and people without HIV (PWoH), we investigated whether air pollution exposure was associated with within-group differences in lung function or respiratory symptoms, and whether these associations differed by HIV serostatus or the presence of underlying lung disease. METHODS: We analyzed cross-sectional data from the Multicenter AIDS Cohort Study (MACS) and the Women’s Interagency HIV Study (WIHS), including participants with pulmonary function tests and accompanying standardized respiratory questionnaires in 2017–2020. The participants were linked to fine particulate matter (PM2.5) and ozone exposure data. Associations between exposures and respiratory outcomes were quantified with regression models. Two subgroup analyses were conducted, restricting to individuals with COPD (FEV1/FVC ratio < 0.7) or impaired DLCO (< 80% predicted). RESULTS: 338 MACS participants and 1073 WIHS participants were included. Overall, there were no significant associations between pollution exposures and either lung function or respiratory symptoms. In PWH with COPD, 1 µg/m3 greater exposure to PM2.5 was associated with worse St. George’s Respiratory Questionnaire (SGRQ) score (4.04 points; 95% CI 0.36–7.72) and worse modified Medical Research Council (mMRC) dyspnea score (0.28 points; 95% CI 0.02–0.53). In PWH with impaired DLCO, 1 µg/m3 greater PM2.5 exposure was associated with worse SGRQ (2.14 points, 95% CI 0.2–4.08) and mMRC (0.16 points, 95% CI 0.02–0.29). There were no significant associations between PM2.5 and respiratory symptoms in PWoH with COPD or impaired DLCO. Ozone exposure was not associated with respiratory symptoms in PWH or PWoH. CONCLUSIONS: PM2.5 exposure may act synergistically with HIV infection to worsen respiratory symptoms in people with chronic lung disease. Further study is needed to determine if air pollution leads to decline in lung function in PWH.