People With Asthma and HIV Require More Noninvasive Positive Pressure Ventilation

Individuals with an acute asthma exacerbation who have HIV have longer associated hospitalizations and are more likely to need treatment with noninvasive positive pressure ventilation (NIPPV), according to study results published in BMJ Open Respiratory Research.

This retrospective study included 462 individuals hospitalized for asthma exacerbation between 2015 and 2017 with a known HIV status; 22.5% (n=104) of the participants were HIV-positive, and 77.5% (n=358) were HIV-negative. Demographic data, comorbidities, laboratory parameters, CD4 count (cells x 10⁶/L), and spirometry data were collected. Individuals with asthma were categorized into 4 strata of asthma severity, and participants who were HIV-positive were stratified into 2 groups, one with higher CD4 counts (≥200 cells x 10⁶/L) and one with lower CD4 counts (<200 cells x 10⁶/L).

The primary outcomes of the study were mortality and use of NIPPV and mechanical ventilation. Secondary outcomes included duration of NIPPV and length of stay. Subgroup analyses were performed to assess the association between ventilation use and mortality, associations with HIV status and study outcomes were analyzed using chi-square tests, and multivariable logistic regression was used to examine the relationship between NIPPV use and HIV status.

Through baseline demographics, researchers assessed that congestive heart failure incidence was higher among individuals without HIV compared with individuals with HIV (16.8% vs 6.7%; P =.016). The group with HIV- had comparatively higher levels of serum creatinine (P =.001) and eosinophils (P =.013), but lower serum levels of neutrophils (P =.0002) and albumin (P =.003). Compared with the individuals who were HIV-negative, those who were HIV-positive required more frequent use of NIPPV (25.4% vs 54.8%, respectively; P <.001) and had a longer length of stay (3.346 vs 2.813 days; P =.015). When comparing the HIV-positive to HIV-negative group, the higher CD4 count group had more frequent NIPPV use (49.2% vs 25.4%, respectively; P =.004) and increased length of stay (3.656 vs 2.813 days; P =.002). However, no statistically significant differences between the high and low CD4 count HIV-positive groups were observed for NIPPV use or length of hospitalization.  Controlling for confounders, multivariable regression revealed an odds ratio of 2.52 (95% CI, 1.43-4.46) for NIPPV use individuals who are HIV-positive, as well as a longer length of stay by 0.55 days (95% CI, 0.02-1.08). 

Limitations to this study included the retrospective design, a potential lack of generalizability due to the specific demographics of participants who all sought medical care from a single center, the potential that the study population’s condition was not severe due to lack of mortality, one of the primary end points, a lack of information on viral panels and blood cultures, a lack of data on discharges before admission and on the daily asthma control of patients with HIV, and the inability to assess whether NIPPV was associated with positive outcomes.

The researchers concluded that individuals “with an HIV-positive status who were admitted to the hospital with acute asthma exacerbation had worse outcomes than did patients with an HIV-negative status.” With regards to CD4 count, individuals “with a higher CD4 count had greater need for NIPPV and had a longer [length of stay].”

Reference

Adrish M, Roa Gomez G, Cancio Rodriguez E, Mantri N. Influence of HIV status on the management of acute asthma exacerbations [published online December 23, 2019]. BMJ Open Respir Res. doi:10.1136/bmjresp-2019-000472