People living with HIV (PLWH) are at greater risk of developing lung diseases even when they are antiretroviral therapy (ART)-adherent and virally suppressed. The most common pulmonary function abnormality in PLWH is that of impaired d iffusing capacity of the l ungs for c arbon monoxide (DL CO ), which is an independent risk factor for increased mortality in PLWH. Earlier work has identified several plasma biomarkers of inflammation and immune activation to be associated with decreased DL CO . However, the underpinning molecular mechanisms of HIV-associated impaired DL CO are largely unknown. We conducted a pilot study of PLWH with normal DL CO (values greater than or equal to the l ower l imit of n ormal, DL CO ≥LLN) or abnormal DL CO (DL CO <LLN) and compared the gene expression levels of over 900 inflammation and immune exhaustion genes using the NanoString technology. We found that 26 genes were differentially expressed in the impaired DL CO group. These genes belong to 4 categories: 1. Nine genes in inflammation and immune activation pathways, 2. seven upregulated genes that are direct targets of the interferon signaling pathway, 3. seven B-cell specific genes that are downregulated, and 4. three miscellaneous genes. These results were corroborated using the bioinformatics tools DAVID (Database for Annotation, Visualization and Integrated Discovery) and GSEA (Gene Sets Enrichment Analysis). Together, the data provides preliminary evidence for the involvement of sustained interferon signaling as a molecular mechanism for impaired DL CO in PLWH. We discuss the implication of these findings in the context of inflammation and interferon as potential therapeutic targets to treat HIV-associated lung dysfunction.