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

• Authors: Matthew Triplette, University of Washington; Amy Justice, Yale University; Engi F. Attia, University of Washington; Janet Tate, Yale University; Sheldon T. Brown, Icahn School of Medicine at Mount Sinai; Matthew Bidwell Goetz, University of California Los Angeles; Joon W. Kim, Icahn School of Medicine at Mount Sinai; Maria C. Rodriguez-Barradas, Baylor College of Medicine; Guy W. Soo Hoo, University of California Los Angeles; Cherry Wongtrakool, Emory University; Kathleen Akgun, Yale University; Kristina Crothers, University of Washington
• Journal Title: AIDS
• Volume: Volume 32, Number 4
• Publisher: Lippincott, Williams & Wilkins | 2018-02-20, Pages 487-493
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/QAD.0000000000001701
• Subjects: Health Sciences, Immunology; Biology, Virology; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; Virology; chronic disease; chronic obstructive pulmonary disease; HIV; pulmonary emphysema; ANTIRETROVIRAL THERAPY ERA; SPIROMETRY REFERENCE VALUES; OF-THE-LITERATURE; RISK-FACTORS; SMOKING-CESSATION; INFECTED PATIENTS; LUNG-FUNCTION; FOLLOW-UP; UNINFECTED VETERANS; COMPUTED-TOMOGRAPHY

Abstract

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.