Effect of HIV on respiratory symptoms, health status, and exertional capacity: a systematic review and meta-analysis

Objective: People living with HIV (PLWH) have increased risk for worse pulmonary function and increased emphysema. HIV has been proposed as a risk factor for respiratory patient-reported outcomes (PROs). We assessed the association of HIV with respiratory symptoms, respiratory health status, and functional exercise capacity. Design: Systematic review and meta-analysis. Methods: We searched PubMed, EMBASE, CENTRAL, CDSR, WoS, Scopus, CINAHL, and GIM through November 2023 for studies of people living with and without HIV reporting respiratory PROs. Primary outcomes were activity-limiting dyspnea (defined as Modified Medical Research Council Dyspnea Scale score≥2), respiratory health status by St. George's Respiratory Questionnaire (SGRQ), and exertional capacity by six-minute walking distance (6MWD). We performed random-effects meta-analyses estimating odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs). Results: We included 89 publications corresponding to 56 studies. HIV was associated with activity-limiting dyspnea (OR 1.67; 95% CI 1.05-2.65), worse respiratory health status (SGRQ MD 2.9 units; 95% CI 0.6-5.2), worse exertional capacity (6MWD MD -58.9 meters; 95% CI -115.3- -2.4), and chronic cough, dyspnea, phlegm, and wheeze (OR 1.38-1.78). Respiratory symptom and adverse respiratory health status risk was greatest in European PLWH. Certainty of evidence was very low, primarily due to studies' observational design and inconsistency. Conclusions: PLWH have increased risk for worse respiratory PROs. Systematic respiratory PRO assessment should be incorporated into routine clinical care to facilitate active case-finding of chronic lung disease in PLWH. Future studies should longitudinally co-assess objective physiologic measures and respiratory PROs.