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Author Notes:

Correspondence to: Matthew Triplette, MD, MPH, Harborview Medical Center, 325 Ninth Ave, Campus Box 359762, Seattle, WA 98104; mtrip@uw.edu

The authors thanks the Veterans who participated in EXHALE and the coordinators who made the study possible.

Dr. Pipavath reports receiving support from Boehringer Ingelheim as a consultant and expert advisor.

Dr. Wongtrakool discloses support from the Department of Veterans Affairs Biomedical Laboratory Research and Development Program, as well as support from Astra-Zeneca as a co-investigator on an industry-sponsored clinical study.

Dr. Goetz reports receiving support from the National Institutes of Health during the conduct of this study.

Drs. Triplette, Attia, Akgün, Campo, Rodriguez-Barradas, Kim, Soo Hoo, Brown and Crothers, as well as Ms. Shahrir, report no conflicts of interest.

We must disclaim that the views expressed in this article are those of the authors and do not necessary reflect the position or policy of the Department of Veterans Affairs.


Research Funding:

This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH) [R01 HL090342 to Dr. Crothers, T32 HL007287-37 supporting Dr. Triplette under Drs. Robb Glenny and J. Randall Curtis] as well as the National Institute on Alcohol Abuse and Alcoholism at the NIH [U01 AA013566].

This research was funded in part by a 2012 developmental grant from the University of Washington Center for AIDS Research, an NIH-funded program under award number P30-AI-027757, which is supported by the following NIH institutes and centers: National Institute of Allergy and Infectious Diseases, National Cancer Institute, National Institute of Mental Health, National Institute on Drug Abuse, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NHLBI, and National Institute on Aging.

This material is the result of work supported with the resources and the use of facilities at the Veterans Affairs Connecticut Healthcare System, West Haven, CT; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; the Atlanta Veterans Affairs Medical Center, Decatur, GA; and the James J. Peters Veterans Affairs Medical Center, Bronx, NY.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Immunology
  • Infectious Diseases
  • COPD
  • emphysema
  • HIV
  • 6-minute walk distance

The Differential Impact of Emphysema on Respiratory Symptoms and 6-Minute Walk Distance in HIV Infection

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Journal Title:

Journal of Acquired Immune Deficiency Syndromes


Volume 74, Number 1


, Pages E23-E29

Type of Work:

Article | Post-print: After Peer Review


Background: Emphysema is more prevalent in HIV-infected (HIV+) patients independent of smoking behavior. Nonetheless, health effects of emphysema in this population are poorly understood. We determined whether emphysema is associated with a greater burden of pulmonary symptoms and a lower 6-minute walk distance (6MWD) in HIV+ compared with HIV-uninfected (HIV-) subjects. Methods: We performed a cross-sectional analysis of 170 HIV+ and 153 HIV- subjects in the Examinations of HIV-Associated Lung Emphysema (EXHALE) cohort study. Subjects completed a self-assessment of respiratory symptoms, pulmonary function testing, and 6MWD testing as well as a chest computed tomography to determine emphysema severity. We used regression models to determine the association of emphysema with respiratory symptoms and 6MWD in HIV+ subjects and compared this to HIV- subjects. Results: Models stratified by HIV status demonstrated an association between > 10% radiographic emphysema and chronic cough and/or phlegm and 6MWD in HIV+ subjects. These associations persisted among the subset without airflow obstruction: those with emphysema had 4.2 (95% confidence interval: 1.3 to 14) times the odds of chronic cough and/or phlegm and walked 60 m (95% confidence interval: 26 to 93) less distance than those without emphysema. There was no association between > 10% emphysema and symptoms or 6MWD in HIV- subjects. Conclusions: In our cohort, > 10% radiographic emphysema was associated with chronic cough and/or phlegm and lower 6MWD in HIV+ but not HIV- subjects. These findings were robust even among HIV+ subjects with milder forms of emphysema and those without airflow obstruction, highlighting the clinical impact of emphysema in these patients.

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