Association between obstructive lung disease and markers of HIV infection in a high-risk cohort
- M Bradley Drummond1,
- Gregory D Kirk1,2,
- Jacquie Astemborski2,
- Mariah M Marshall2,
- Shruti H Mehta2,
- John F McDyer1,
- Robert H Brown1,
- Robert A Wise1,
- Christian A Merlo1
- 1Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- 2Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Correspondence to Dr M Bradley Drummond, Division of Pulmonary and Critical Care Medicine, 5501 Hopkins Bayview Circle, JHAAC 4B.70, Baltimore, MD 21224, USA;
Contributors MBD and CAM were responsible for study design, data analysis and interpretation, initial drafting of the article and revisions. MBD takes full responsibility for the integrity of the work as a whole, from inception to published article. MMM, SHM, JFM, RHB and RAW were responsible for study conception and design, data interpretation and critical revisions for important intellectual content. GDK and JA were responsible for study design, data analysis, data interpretation and critical revisions for important intellectual content. All authors gave final approval of the submitted manuscript.
- Received 28 June 2011
- Accepted 26 October 2011
- Published Online First 16 November 2011
Background Evidence suggests an association between HIV infection and the presence of obstructive lung disease (OLD). However, the associations between specific markers of HIV infection and OLD remain unclear. A study was undertaken to determine the independent associations of HIV infection, CD4 cell count and plasma HIV viral load with the presence of OLD in an urban cohort.
Methods Clinical, laboratory and spirometric data from the AIDS Linked to the Intravenous Experience (ALIVE) study, an observational study of current and former injection drug users in Baltimore, Maryland, were analysed. Multivariable logistic regression models were generated to identify HIV infection indices independently associated with OLD.
Results Of 1077 participants (mean±SD age 48±8 years), 89% were African-American, 65% were men and 86% were current smokers. A total of 303 (28%) were HIV infected and 176 (16%) had spirometry-defined OLD. Higher viral load was independently associated with OLD. HIV-infected individuals with viral load >200 000 copies/ml had a 3.4-fold increase in the odds of OLD compared with HIV-negative participants (95% CI 1.24 to 9.39; p=0.02). The association between higher HIV viral load and OLD persisted after accounting for antiretroviral therapy use (OR 4.06, 95% CI 1.41 to 11.7; p=0.01). No association was observed between HIV serostatus or CD4 cell count and the presence of OLD.
Conclusion In a cohort at risk for OLD and HIV infection, high viral load but not CD4 cell count was associated with an increased prevalence of spirometry-defined OLD. These findings suggest that higher viral load may contribute mechanistically to the increased risk of OLD in patients with HIV infection.
- HIV infection
- pulmonary disease
- chronic obstructive
- lung diseases
- COPD mechanisms
- COPD epidemiology
- COPD exacerbations
- COPD pathology
- COPD pharmacology
- ambulatory oxygen therapy
- asthma epidemiology
- lung physiology
Funding This study was funded in part by grants from the National Institutes of Health (Grants HL090483, DA04334 and DA12568). MBD by a grant from the National Institutes of Health National Heart, Lung and Blood Institute (K23HL103192).
Competing interests None.
Ethics approval Johns Hopkins Hospital Institutional Review Board (Approval NA_00020295).
Provenance and peer review Not commissioned; externally peer reviewed.