Co-Infected HIV/Hepatitis Patients Compared With Chronic Liver Patients and Healthy Individuals: Respiratory Assessment Through Surface Electromyography and Spirometry A.M. Oliveira da Silva a , D.C. Dos Santos a,b , V. Limongi a,b , E.S.L. Gonçalez b,c , M.N. Pedro b,c , R.S.B. Stucchi a , and I.F.S.F. Boin a,d, * a Liver Transplantation Unit, State University of Campinas, Campinas, Brazil; b Department of Medical Science, State University of Campinas, Campinas, Brazil; c Clinical Hospital of State University of Campinas, Campinas, Brazil; d Department of Surgery, Unit of Liver Transplantation, State University of Campinas, Campinas, Brazil ABSTRACT Introduction. Co-infected HIV and hepatitis subjects are candidates for a liver trans- plantation because of progressive liver disease. Chronic liver disease, co-infected or not, requires assessment of respiratory function before liver transplantation. The respiratory evaluation of these 2 groups compared with healthy individuals can define deficits, and this can impair a full recovery after transplant surgery. Objective. This study sought to compare the respiratory profile in co-infected patients with chronic liver disease who are candidates for liver transplantation with that of healthy subjects. Methods. Through respiratory evaluation of flows and lung volumes (spirometry), muscle activity (surface electromyography), and maximum pressure (manovacuometer), 250 peo- ple were distributed into 3 groups: 14 patients with HIV and liver disease, 65 healthy subjects, and 171 patients with chronic liver disease. The mean age (years) was respectively 47.5  6.2, 48.3  14.1, and 52.9  8.5. The average body mass index (kg/m 2 ) of the groups was 24.6  4.5, 26.0  3.2, and 28.5  5.3, respectively. Results. There was a statistical difference among the groups in the root means square (RMS) rectus abdominis (mV) (P ¼ .0016), RMS diaphragm (mV) (P ¼ .0001), maximal inspiratory pressure (cmH 2 O) (P ¼ .001), forced exhaled volume at the end of first second (%) (P ¼ .002), and maximal mid expiratory flow 25% to 75% (%) (P ¼ .0001) for the Kruskal-Wallis test. The multivariate analysis among the groups showed that the RMS diaphragm had a tendency to discriminate the co-infected subjects. Conclusions. The co-infected HIV group showed a muscle deficit of diaphragm and rectus abdominis activity, and the liver disease group showed lower indexes in volumes and respiratory flows. I NDIVIDUALS with AIDS caused by HIV have a need for medical monitoring and drug therapy, especially when there is co-infection mainly with hepatitis C virus (HCV), which can lead to metabolic and dystrophic injuries [1e3]. One of the treatments proposed is liver trans- plantation [2]. In this case, the respiratory function of chronic liver disease pretransplantation patients should be evaluated periodically, with the aim being good post- operative results [4]. The goal of this study was to evaluate the respiratory function of healthy individuals compared with that of chronic liver disease patients (CLDP) and CLDP co-infected with HIV. A.M. Oliveira da Silva was supported by FAPESP 10/19326-5. I. Boin was supported by FAEPEX n 7408/09. *Address correspondence to Ilka Boin, Rua Carlos Chagas, 420/Campinas/SP, Brazil 13084-970. E-mail: ilkaboin@yahoo. com ª 2014 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 0041-1345/14 http://dx.doi.org/10.1016/j.transproceed.2014.07.015 Transplantation Proceedings, 46, 3039e3042 (2014) 3039