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HIV Infection Increases Susceptibility to Smoking-Induced Emphysema* FREE TO VIEW

Philip T. Diaz, MD; Eric R. King, MD; Mark D. Wewers, MD; James E. Gadek, MD; David Neal, MD; Janice Drake; Thomas L. Clanton, PhD
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*From Ohio State University, Columbus, OH.

Correspondence to: Philip T. Diaz, MD, Division of Pulmonary and Critical Care Medicine, Ohio State University Medical Center, N325 Means Hall, 1654 Upham Dr, Columbus, OH 43210-1228

Chest. 2000;117(5_suppl_1):285S. doi:10.1378/chest.117.5_suppl_1.285S
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Abbreviations: BMI = body mass index; HRCT = high-resolution CT

Background: A number of uncontrolled reports have suggested that prior to the development of AIDS-related pulmonary complications, individuals infected with HIV may develop an accelerated form of lung damage consistent with an emphysema-like process. Confirming this observation may have important implications for our understanding of emphysema pathogenesis.

Methods: We prospectively evaluated 114 clinically stable HIV-positive subjects with high-resolution CT (HRCT) of the chest. Forty-four HIV-negative subjects matched for age and smoking history served as control subjects. Scans were interpreted for the presence and severity of emphysema. BAL was performed in agreeable subjects to exclude occult opportunistic infection and to examine cellular characteristics that might be correlated with emphysema development.

Results: The percentage of subjects meeting emphysema criteria was significantly higher in the HIV-positive group. Among clinical variables, low body mass index (BMI) and cigarette smoking were independently correlated with emphysema. There appeared to be a marked susceptibility to smoking-induced lung damage among HIV-positive subjects: nearly 40% with a > 12-pack-year history of cigarette smoking met criteria for emphysema, vs 0 of 14 control subjects with a similar smoking history (p < 0.01). BAL revealed no occult pathogens to explain the HRCT changes; however, the percent of lymphocytes bearing the cytotoxic phenotype was highest among HIV-positive smokers with emphysema.

Conclusions: HIV infection is associated with an increased susceptibility to smoking-associated lung damage. The presence of emphysema is associated with decreased BMI and increased BAL cytotoxic lymphocytes.




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