Increased susceptibility to pulmonary emphysema among HIV-seropositive smokers

PT Diaz, MA King, ER Pacht, MD Wewers… - Annals of internal …, 2000 - acpjournals.org
PT Diaz, MA King, ER Pacht, MD Wewers, JE Gadek, HN Nagaraja, J Drake, TL Clanton
Annals of internal medicine, 2000acpjournals.org
Background: Previous uncontrolled reports have suggested that HIV-seropositive persons
develop an accelerated form of emphysema. Objective: To characterize the risk for
emphysema in a stable HIV-seropositive outpatient population. Design: Controlled, cross-
sectional analysis. Setting: Midwestern urban community. Participants: HIV-seropositive
persons (n= 114) without AIDS-related pulmonary complications and HIV-seronegative
controls (n= 44), matched for age and smoking history. Measurements: Measurement of …
Background
Previous uncontrolled reports have suggested that HIV-seropositive persons develop an accelerated form of emphysema.
Objective
To characterize the risk for emphysema in a stable HIV-seropositive outpatient population.
Design
Controlled, cross-sectional analysis.
Setting
Midwestern urban community.
Participants
HIV-seropositive persons (n = 114) without AIDS-related pulmonary complications and HIV-seronegative controls (n = 44), matched for age and smoking history.
Measurements
Measurement of pulmonary function, bronchoalveolar lavage, and high-resolution computed tomography of the chest.
Results
The incidence of emphysema was 15% (17 of 114) in the HIV-seropositive group compared with 2% (1 of 44) in the HIV-seronegative group (P = 0.025). The incidence of emphysema in participants with a smoking history of 12 pack-years or greater was 37% (14 of 38 persons) in the HIV-seropositive group compared with 0% (0 of 14 persons) in the HIV-seronegative group (P = 0.011). The percentage of cytotoxic lymphocytes in lavage fluid was much higher in HIV-seropositive smokers with emphysema.
Conclusions
Infection with HIV accelerates the onset of smoking-induced emphysema. The results of this study support the emerging concept that cytotoxic lymphocytes may have an important role in emphysema pathogenesis.
acpjournals.org