Abstract
BackgroundChronic obstructive pulmonary disease (COPD) and emphysema are common amongst patients with human immunodeficiency virus (HIV). We sought to determine the clinical factors that are associated with emphysema progression in HIV.Methods345 HIV-infected patients enrolled in an outpatient HIV metabolic clinic with ≥2 chest computed tomography scans made up the study cohort. Images were qualitatively scored for emphysema based on percentage involvement of the lung. Emphysema progression was defined as any increase in emphysema score over the study period. Univariate analyses of clinical, respiratory, and laboratory data, as well as multivariable logistic regression models, were performed to determine clinical features significantly associated with emphysema progression.Results17.4% of the cohort were emphysema progressors. Emphysema progression was most strongly associated with having a low baseline diffusion capacity of carbon monoxide (DLCO) and having combination centrilobular and paraseptal emphysema distribution. In adjusted models, the odds ratio (OR) for emphysema progression for every 10% increase in DLCO percent predicted was 0.58 (95% confidence interval [CI] 0.41–0.81). The equivalent OR (95% CI) for centrilobular and paraseptal emphysema distribution was 10.60 (2.93–48.98). Together, these variables had an area under the curve (AUC) statistic of 0.85 for predicting emphysema progression. This was an improvement over the performance of spirometry (forced expiratory volume in 1 second to forced vital capacity ratio), which predicted emphysema progression with an AUC of only 0.65.ConclusionCombined paraseptal and centrilobular emphysema distribution and low DLCO could identify HIV patients who may experience emphysema progression.
Highlights
Chronic obstructive pulmonary disease (COPD) is characterized by small airway remodeling and emphysematous lung destruction and is an important comorbidity in patients living with human immunodeficiency virus (HIV)[1, 2] contributing to substantial respiratory symptom burdens[3, 4]
We speculate that the particular pathology of emphysema in HIV that appears in such accelerated form may be the synergistic product of these two processes, toxic particle exposure in the respiratory bronchioles and vascular insufficiency in the distal acinus
Having a combination of both distributions was associated with severity of disease, distribution may be a marker for patients with an accelerated phenotype of COPD
Summary
Chronic obstructive pulmonary disease (COPD) is characterized by small airway remodeling and emphysematous lung destruction and is an important comorbidity in patients living with human immunodeficiency virus (HIV)[1, 2] contributing to substantial respiratory symptom burdens[3, 4]. HIV patients with severe emphysema burdens as visualized on computed tomographic (CT) scanning can have surprisingly well-preserved spirometry[7]. This stands in contrast to HIV-uninfected subjects in whom emphysema quantitation correlates strongly with forced expiratory volume in 1 second (FEV1) measurements[8]. Chronic obstructive pulmonary disease (COPD) and emphysema are common amongst patients with human immunodeficiency virus (HIV). We sought to determine the clinical factors that are associated with emphysema progression in HIV
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