In a study conducted prior to the widespread availability of highly active antiretroviral therapy (HAART), HIV positive (HIV+) patients were reported to have accelerated emphysema compared to HIV negative (HIV-) patients. In the current HAART era, we asked whether HIV infection was independently associated with chronic obstructive lung disease (OLD).
We studied veterans enrolled in the 5-site Veterans Aging Cohort Study, a prospective longitudinal study of 1042 HIV+ and 750 HIV- patients. Smoking status, pack years of smoking, and patient-reported physician diagnosis of OLD (chronic obstructive pulmonary disease, chronic bronchitis, emphysema or asthma) were obtained at baseline from patient survey. Patients were also asked if they had trouble with cough or dyspnea, and to what degree this symptom was bothersome.
895 HIV+ and 653 HIV- veterans with known smoking status were included in this analysis. HIV+ veterans were more likely to be current smokers (45% HIV+ vs 36% HIV-, p<0.001), whereas HIV- veterans were more likely to be former smokers (27% HIV+ vs 37% HIV-, p<0.001). HIV+ veterans had fewer pack years of smoking compared to HIV- veterans (median of 16 pack years vs 20 pack years, p=0.003). Dyspnea that was bothersome was equally prevalent in both populations (43% HIV+ vs 40% HIV-, p=0.2). HIV+ veterans were younger and more likely to be African American, both of which were associated with a decreased likelihood of OLD. However, after adjusting for age, race, and pack years of smoking, HIV+ veterans were 59% more likely to have OLD (OR=1.59, 95% CI=1.15-2.19).
HIV+ veterans were more likely to be diagnosed with OLD than HIV- veterans. These results are consistent with the possibility that HIV+ patients on effective antiretroviral therapy have an increased susceptibility to OLD.
As HIV+ patients are living longer on HAART, non-infectious complications such as OLD may contribute substantially to the morbidity and mortality of these patients. The possibility that HIV accelerates OLD deserves further investigation.
K.A. Crothers, None.