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(Chest. 2006;130:1326-1333.)
© 2006 American College of Chest Physicians

Increased COPD Among HIV-Positive Compared to HIV-Negative Veterans*

Kristina Crothers, MD; Adeel A. Butt, MD, MS; Cynthia L. Gibert, MD; Maria C. Rodriguez-Barradas, MD; Stephen Crystal, PhD; Amy C. Justice, MD, PhD; for the Veterans Aging Cohort 5 Project Team

* From Pulmonary and Critical Care Medicine (Dr. Crothers), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Infectious Diseases (Dr. Butt), Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; the Department of Medicine (Dr. Gibert), George Washington University, Washington DC; Medical Service (Dr. Rodriguez-Barradas), Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Center on Pharmacotherapy (Dr. Crystal), Chronic Disease Management, and Outcomes, Rutgers University, New Brunswick, NJ; and General Internal Medicine (Dr. Justice), Department of Internal Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT.

Correspondence to: Amy C. Justice, MD, PhD, VA Connecticut Healthcare System, 950 Campbell Ave, Mailstop 11-ACSLG, West Haven, CT 06516; e-mail: amy.justice2{at}va.gov

Abstract

Background: Limited data prior to highly active antiretroviral therapy (HAART) suggested the possibility of an increased risk of COPD among those persons with HIV infection. We sought to determine whether HIV infection is associated with increased prevalence of COPD in the era of HAART.

Methods: Prospective observational study of 1,014 HIV-positive and 713 HIV-negative men who were enrolled in the Veterans Aging Cohort 5 Site Study. COPD was determined by patient self-report and International Classification of Diseases, ninth revision (ICD-9), diagnostic codes. Cigarette smoking and injection drug use (IDU) were determined by self-report, and alcohol abuse was determined by ICD-9 diagnostic codes. Laboratory and pharmacy data were obtained from electronic medical records.

Results: The prevalence of COPD as determined by ICD-9 codes was 10% in HIV-positive subjects and 9% in HIV-negative subjects (p = 0.4), and as determined by patient self-report was 15% and 12%, respectively (p = 0.04). After adjusting for age, race/ethnicity, pack-years of smoking, IDU, and alcohol abuse, HIV infection was an independent risk factor for COPD. HIV-infected subjects were approximately 50 to 60% more likely to have COPD than HIV-negative subjects (by ICD-9 codes: odds ratio [OR], 1.47; 95% confidence interval [CI], 1.01 to 2.13; p = 0.04 ; by patient self-report: OR, 1.58; 95% CI, 1.14 to 2.18; p = 0.005).

Conclusions: HIV infection was an independent risk factor for COPD, when determined either by ICD-9 codes or patient self-report. Health-care providers should be aware of the increased likelihood of COPD among their HIV-positive patients. The possibility that HIV infection increases susceptibility to and/or accelerates COPD deserves further investigation and has implications regarding the pathogenesis of COPD.

Key Words: AIDS • HIV infection • obstructive lung diseases • smoking






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