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. 2011 Feb 1;183(3):388-95.
doi: 10.1164/rccm.201006-0836OC. Epub 2010 Sep 17.

HIV infection and risk for incident pulmonary diseases in the combination antiretroviral therapy era

Kristina Crothers  1 , Laurence Huang, Joseph L Goulet, Matthew Bidwell Goetz, Sheldon T Brown, Maria C Rodriguez-Barradas, Krisann K Oursler, David Rimland, Cynthia L Gibert, Adeel A Butt, Amy C Justice
Affiliations

HIV infection and risk for incident pulmonary diseases in the combination antiretroviral therapy era

Kristina Crothers et al. Am J Respir Crit Care Med. .

Abstract

Rationale: In aging HIV-infected populations comorbid diseases are important determinants of morbidity and mortality. Pulmonary diseases have not been systematically assessed in the combination antiretroviral therapy (ART) era.

Objectives: To determine the incidence of pulmonary diseases in HIV-infected persons compared with HIV-uninfected persons.

Methods: We analyzed data from the Veterans Aging Cohort Study Virtual Cohort, consisting of 33,420 HIV-infected veterans and 66,840 age, sex, race and ethnicity, and site-matched HIV-uninfected veterans. Using Poisson regression, incidence rates and adjusted incidence rate ratios were calculated to determine the association of HIV with pulmonary disease. The Virtual Cohort was merged with the 1999 Veterans Large Health Survey to adjust for self-reported smoking in a nested sample (14%).

Measurements and main results: Incident chronic obstructive pulmonary disease, lung cancer, pulmonary hypertension, and pulmonary fibrosis, as well as pulmonary infections, were significantly more likely among HIV-infected patients compared with uninfected patients in adjusted analyses, although rates of asthma did not differ by HIV status. Bacterial pneumonia and chronic obstructive pulmonary disease were the two most common incident pulmonary diseases, whereas opportunistic pneumonias were less common. Absolute rates of most pulmonary diseases increased with age, although the relative differences between those with and without HIV infection were greatest in younger persons. Chronic obstructive pulmonary disease and asthma, as well as pulmonary infections, were less likely in those with lower HIV RNA levels and use of ART at baseline.

Conclusions: Pulmonary diseases among HIV-infected patients receiving care within the Veterans Affairs Healthcare System in the combination ART era reflect a substantial burden of non-AIDS-defining and chronic conditions, many of which are associated with aging.

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Figures

Figure 1.
Figure 1.
(A and B) Unadjusted incidence per 1,000 person-years of pulmonary disease by HIV status. Incidence rates of each pulmonary condition are shown per 1,000 person-years on the y axis. Rates for HIV-infected patients (HIV+) are shown in the solid bars, and for HIV-uninfected patients (HIV−) are shown in the shaded bars. *P < 0.05 for HIV+ compared with HIV− patients. COPD = chronic obstructive pulmonary disease; PCP = Pneumocystis pneumonia; TB = tuberculosis.
Figure 2.
Figure 2.
Incidence of chronic obstructive pulmonary disease and lung cancer by age and HIV status. Incidence rates of chronic obstructive pulmonary disease (A) and lung cancer (B) are shown per 1,000 person-years on the y axis. Rates for HIV-infected patients (HIV+) are shown in the solid bars, and for HIV-uninfected patients (HIV−) are shown in the shaded bars. The incidence of chronic obstructive pulmonary disease and of lung cancer both increase significantly according to age (P trend < 0.001 for HIV-infected and uninfected patients for each condition).
Figure 3.
Figure 3.
Model for accelerated progression of chronic lung diseases among patients infected with HIV. The intersection of HIV, smoking, substance use, and other host-related factors may lead to systemic and lung-specific effects, including infections and colonization (especially in the setting of HIV-related immune incompetence); oxidative stress induced by HIV infection, smoking, and other exposures; and systemic immune dysfunction characterized by persistent immune activation and chronic inflammation. These may lead to lung inflammation and injury via a variety of mechanisms and subsequent lung function decline, culminating in the clinical manifestation of chronic obstructive pulmonary disease and other chronic lung diseases. COPD = chronic obstructive pulmonary disease.
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References

    1. Rosen MJ, Clayton K, Schneider RF, Fulkerson W, Rao AV, Stansell J, Kvale PA, Glassroth J, Reichman LB, Wallace JM, et al. Intensive care of patients with HIV infection: utilization, critical illnesses, and outcomes. Pulmonary Complications of HIV Infection Study Group. Am J Respir Crit Care Med 1997;155:67–71. - PubMed
    1. Murray JF, Mills J. Pulmonary infectious complications of human immunodeficiency virus infection. Part I. Am Rev Respir Dis 1990;141:1356–1372. - PubMed
    1. Wallace JM, Hansen NI, Lavange L, Glassroth J, Browdy BL, Rosen MJ, Kvale PA, Mangura BT, Reichman LB, Hopewell PC. Respiratory disease trends in the Pulmonary Complications of HIV Infection Study cohort. Pulmonary Complications of HIV Infection Study Group. Am J Respir Crit Care Med 1997;155:72–80. - PubMed
    1. Diaz PT, King MA, Pacht ER, Wewers MD, Gadek JE, Nagaraja HN, Drake J, Clanton TL. Increased susceptibility to pulmonary emphysema among HIV-seropositive smokers. Ann Intern Med 2000;132:369–372. - PubMed
    1. Crothers K, Butt AA, Gibert CL, Rodriguez-Barradas MC, Crystal S, Justice AC. Increased COPD among HIV-positive compared to HIV-negative veterans. Chest 2006;130:1326–1333. - PubMed

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