Chest
Volume 130, Issue 5, November 2006, Pages 1326-1333
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Original Research
Increased COPD Among HIV-Positive Compared to HIV-Negative Veterans

https://doi.org/10.1378/chest.130.5.1326Get rights and content

Background

Limited data prior to highly active antiretroviral therapy (HAART) suggested the possibility of an increased risk of COPD among those persons with HIV infection. We sought to determine whether HIV infection is associated with increased prevalence of COPD in the era of HAART.

Methods

Prospective observational study of 1,014 HIV-positive and 713 HIV-negative men who were enrolled in the Veterans Aging Cohort 5 Site Study. COPD was determined by patient self-report and International Classification of Diseases, ninth revision (ICD-9), diagnostic codes. Cigarette smoking and injection drug use (IDU) were determined by self-report, and alcohol abuse was determined by ICD-9 diagnostic codes. Laboratory and pharmacy data were obtained from electronic medical records.

Results

The prevalence of COPD as determined by ICD-9 codes was 10% in HIV-positive subjects and 9% in HIV-negative subjects (p = 0.4), and as determined by patient self-report was 15% and 12%, respectively (p = 0.04). After adjusting for age, race/ethnicity, pack-years of smoking, IDU, and alcohol abuse, HIV infection was an independent risk factor for COPD. HIV-infected subjects were approximately 50 to 60% more likely to have COPD than HIV-negative subjects (by ICD-9 codes: odds ratio [OR], 1.47; 95% confidence interval [CI], 1.01 to 2.13; p = 0.04 ; by patient self-report: OR, 1.58; 95% CI, 1.14 to 2.18; p = 0.005).

Conclusions

HIV infection was an independent risk factor for COPD, when determined either by ICD-9 codes or patient self-report. Health-care providers should be aware of the increased likelihood of COPD among their HIV-positive patients. The possibility that HIV infection increases susceptibility to and/or accelerates COPD deserves further investigation and has implications regarding the pathogenesis of COPD.

Section snippets

Materials and Methods

VACS 5 is an observational study of 1,031 HIV-positive and 740 HIV-negative subjects matched for age, race, and site who were enrolled from 2001 to 2002 from the outpatient infectious disease and general medicine clinics at five US Veterans Affairs (VA) medical centers. The institutional review boards approved the study at all locations, and participants provided written informed consent. All consecutive HIV-positive patients were eligible to participate, and the 1,031 HIV-positive subjects

Results

We excluded female subjects (n = 42) and those subjects without a known smoking status (n = 2). Thus, 1,727 of 1,771 subjects (98%) who were enrolled in VACS 5 were included in the analytic sample.

Discussion

In this study, we found that HIV infection was an independent risk factor for COPD in the present HAART era. Although the prevalence of COPD was not significantly different in HIV-positive and HIV-negative subjects by univariate analysis, the HIV-positive subjects were significantly younger and had smoked fewer pack-years of cigarettes than the HIV-negative subjects. Both of these factors would be expected to decrease the likelihood of COPD in the HIV-positive group. However, after we adjusted

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    This research was supported by National Institutes of Health/National Center for Research Resources grant K12 RR0117594-01 (to K.C.), National Institute on Alcohol Abuse and Alcoholism grant 3U01 AA 13566, National Institute on Aging (NIA) grant K23 AG00826, a Robert Wood Johnson Generalist Faculty Scholar Award, and an Interagency Agreement among NIA, National Institute of Mental Health, and Veterans Health Affairs (to A.C.J.).

    Data for this study were collected from subjects enrolled in VACS 5 at five Veterans Affairs Medical Centers in the United States (Atlanta, the Bronx, Houston, Los Angeles, and Manhattan). Data were analyzed at the coordinating center at the West Haven Veterans Affairs Medical Center, West Haven, CT.

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