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Author Notes:

Corresponding Author: Matthew Triplette, 325 9th Avenue, Campus Box 359762 Seattle, Washington 98104. mtrip@uw.edu.

Author contributions: MT, AJ, JT, KA, KC contributed to the conception and design of the manuscript; AJ, JT, STB, MBG, JWK, MCRB, GWSH, CW, KC contributed to the acquisition of data; MT, AJ, EFA, JT, KC conducted the data analysis and interpretation of the data; MT drafted the article; all authors revised the article for important intellectual content and approved the final version of the article.

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

This material is the result of work supported with the resources and the use of facilities at the Veterans Affairs Connecticut Healthcare System, New 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.


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, and T32 HL007287 supporting Dr. Triplette under Drs. Robb Glenny and J. Randall Curtis).


  • Science & Technology
  • Life Sciences & Biomedicine
  • Immunology
  • Infectious Diseases
  • Virology
  • chronic disease
  • chronic obstructive pulmonary disease
  • HIV
  • pulmonary emphysema

Markers of chronic obstructive pulmonary disease are associated with mortality in people living with HIV

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Journal Title:



Volume 32, Number 4


, Pages 487-493

Type of Work:

Article | Post-print: After Peer Review


Objective: Aging people living with HIV (PLWH) face an increased burden of comorbidities, including chronic obstructive pulmonary disease (COPD). The impact of COPD on mortality in HIV remains unclear. We examined associations between markers of COPD and mortality among PLWH and uninfected study participants. Design: Longitudinal analysis of the Examinations of HIV-Associated Lung Emphysema (EXHALE) cohort study. Methods: EXHALE includes 196 PLWH and 165 uninfected smoking-matched study participants who underwent pulmonary function testing and computed tomography (CT) to define COPD and were followed. We determined associations between markers of COPD with mortality using multivariable Cox regression models, adjusted for smoking and the Veterans Aging Cohort Study (VACS) Index, a validated predictor of mortality in HIV. Results: Median follow-up time was 6.9 years; the mortality rate was 2.7/100 person-years among PLWH and 1.7/100 person-years among uninfected study participants (P = 0.11). The VACS Index was associated with mortality in both PLWH and uninfected study participants. In multivariable models, pulmonary function and CT characteristics defining COPD were associated with mortality in PLWH: Those with airflow obstruction (forced expiratory volume in 1 s/ forced vital capacity <0.7) had 3.1 times the risk of death [hazard ratio 3.1 (95% confidence interval 1.4-7.1)], compared with those without; those with emphysema (>10% burden) had 2.4 times the risk of death [hazard ratio 2.4 (95% confidence interval 1.1-5.5)] compared with those with ≤ 10% emphysema. In uninfected subjects, pulmonary variables were not significantly associated with mortality, which may reflect fewer deaths limiting power. Conclusion: Markers of COPD were associated with greater mortality in PWLH, independent of the VACS Index. COPD is likely an important contributor to mortality in contemporary PLWH.

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