Risk factors associated with acute exacerbation of chronic obstructive pulmonary disease in HIV-infected and uninfected patients

• Authors: T.B. Depp, University of South Carolina; K.A. McGinnis, VA Pittsburgh Healthcare System; K. Kraemer, VA Pittsburgh Healthcare System; K.M. Akguen, VA Connecticut Healthcare System; E.J. Edelman, Yale University; D.A. Fiellin, Yale University; A.A. Butt, VA Pittsburgh Healthcare System; S. Crystal, Rutgers University; A.J. Gordon, VA Pittsburgh Healthcare System; M. Freiberg, Vanderbilt University; C.L. Gibert, Washington DC VA Medical Center; David Rimland, Emory University; K.J. Bryant, National Institutes of Health; K. Crothers, University of Washington
• Journal Title: AIDS
• Volume: Volume 30, Number 3
• Publisher: Lippincott, Williams & Wilkins | 2016-01-28, Pages 455-463
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/QAD.0000000000000940
• Subjects: Health Sciences, General; Health Sciences, Immunology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; Virology; acute exacerbation; AECOPD; AIDS/HIV; chronic obstructive pulmonary disease; cigarette smoking; COPD; tobacco use; unhealthy alcohol use; ANTIRETROVIRAL THERAPY ERA; COPD EXACERBATIONS; UNITED-STATES; LUNG-DISEASE; ALCOHOL-USE; CARE; HEALTH; VETERANS; EPIDEMIOLOGY; MORTALITY

Abstract

Objective: To determine the association between HIV infection and other risk factors for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Design: Longitudinal, national Veterans Aging Cohort Study including 43 618 HIV-infected and 86 492 uninfected veterans. Methods: AECOPD was defined as an inpatient or outpatient COPD ICD-9 diagnosis accompanied by steroid and/or antibiotic prescription within 5 days. We calculated incidence rate ratios (IRR) and 95% confidence intervals (CI) for first AECOPD over 2 years and used Poisson regression models to adjust for risk factors. Results: Over 234 099 person-years of follow-up, 1428 HIV-infected and 2104 uninfected patients had at least one AECOPD. HIV-infected patients had an increased rate of AECOPD compared with uninfected (18.8 vs. 13.3 per 1000 person-years, P < 0.001). In adjusted models, AECOPD risk was greater in HIV-infected individuals overall (IRR 1.54; 95% CI 1.44-1.65), particularly in those with more severe immune suppression when stratified by CD4 cell count (cells/ml) compared with uninfected (HIV-infected CD4+ < 200: IRR 2.30, 95% CI 2.10-2.53, HIV-infected CD4+ ≥ 200-349: IRR 1.32, 95% CI 1.15-1.51, HIV-infected CD4+≥350: IRR 0.99, 95% CI 0.88-1.10). HIV infection also modified the association between current smoking and alcohol-related diagnoses with risk for AECOPD such that interaction terms for HIV and current smoking or HIV and alcohol-related diagnoses were each significantly associated with AECOPD. Conclusion: HIV infection, especially with lower CD4+ cell count, is an independent risk factor for AECOPD. Enhanced susceptibility to harm from current smoking or unhealthy alcohol use in HIV-infected patients may also contribute to the greater rate of AECOPD.