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Increased Susceptibility to Pulmonary Emphysema among HIV-Seropositive Smokers
- Philip T. Diaz, MD;
- Mark A. King, MD;
- Eric R. Pacht, MD;
- Mark D. Wewers, MD;
- James E. Gadek, MD;
- Haikady N. Nagaraja, PhD;
- Janice Drake; and
- Thomas L. Clanton, PhD
Abstract
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.
- HIV seropositivity
- Smoking
- Pulmonary emphysema
- Human immunodeficiency virus infections
- T-lymphocytes, cytotoxic
Article and Author Information
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Acknowledgments: The authors thank Tina Bees and Valerie Wright for assistance in manuscript preparation.
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Grant Support: By National Heart, Lung, and Blood Institute grants RO1-HL49730 and RO1HL53229 and by Clinical Research Center Grant 2MO1-RR0034.
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Requests for Single Reprints: Philip T. Diaz, MD, Pulmonary and Critical Care Medicine, North 325 Means Hall, 1654 Upham Drive, Columbus, OH 43210-1228.
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Requests To Purchase Bulk Reprints (minimum, 100 copies): Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
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Current Author Addresses: Drs. Diaz, Pacht, Wewers, Gadek, Drake, and Clanton: Pulmonary and Critical Care Division, Department of Internal Medicine, Ohio State University, N-325 Means Hall, 1654 Upham Drive, Columbus, OH 43210.
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Dr. King: Department of Radiology, Ohio State University, N-325 Means Hall, 1654 Upham Drive, Columbus, OH 43210.
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Dr. Nagaraja: Department of Statistics, Ohio State University, N-325 Means Hall, 1654 Upham Drive, Columbus, OH 43210.
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Author Contributions: Conception and design: P.T. Diaz, M.A. King, E.R. Pacht, M.D. Wewers, J.E. Gadek, J. Drake, T.L. Clanton.
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Analysis and interpretation of data: P.T. Diaz, M.A. King, E.R. Pacht, J.E. Gadek, H.N. Nagaraja, T.L. Clanton.
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Drafting of the article: P.T. Diaz.
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Critical revision of the article for important intellectual content: P.T. Diaz, M.A. King, M.D. Wewers, J.E. Gadek, H.N. Nagaraja, T.L. Clanton.
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Final approval of the article: P.T. Diaz, M.A. King, E.R. Pacht, M.D. Wewers, J.E. Gadek, H.N. Nagaraja, J. Drake, T.L. Clanton.
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Provision of study materials or patients: P.T. Diaz.
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Statistical expertise: H.N. Nagaraja, T.L. Clanton.
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Obtaining of funding: P.T. Diaz, M.D. Wewers.
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Administrative, technical, or logistic support: P.T. Diaz.
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Collection and assembly of data: M.A. King, J. Drake.
- Copyright ©2004 by the American College of Physicians
