title: Increased susceptibility to pulmonary emphysema among HIV-seropositive smokers.
abstract: BACKGROUND
  Previous uncontrolled reports have suggested that HIV-seropositive persons develop an accelerated form of emphysema.
  
  
  OBJECTIVE
  To characterize the risk for emphysema in a stable HIV-seropositive outpatient population.
  
  
  METHODS
  Controlled, cross-sectional analysis.
  
  
  METHODS
  Midwestern urban community.
  
  
  METHODS
  HIV-seropositive persons (n = 114) without AIDS-related pulmonary complications and HIV-seronegative controls (n = 44), matched for age and smoking history.
  
  
  METHODS
  Measurement of pulmonary function, bronchoalveolar lavage, and high-resolution computed tomography of the chest.
  
  
  RESULTS
  The incidence of emphysema was 15% (17 of 114) in the HIV-seropositive group compared with 2% (1 of 44) in the HIV-seronegative group (P = 0.025). The incidence of emphysema in participants with a smoking history of 12 pack-years or greater was 37% (14 of 38 persons) in the HIV-seropositive group compared with 0% (0 of 14 persons) in the HIV-seronegative group (P = 0.011). The percentage of cytotoxic lymphocytes in lavage fluid was much higher in HIV-seropositive smokers with emphysema.
  
  
  CONCLUSIONS
  Infection with HIV accelerates the onset of smoking-induced emphysema. The results of this study support the emerging concept that cytotoxic lymphocytes may have an important role in emphysema pathogenesis.
authors.affiliation: Department of Internal Medicine, Ohio State University, Columbus 43210, USA.
authors.forename: P T
authors.initials: PT
authors.lastname: Diaz
authors.forename: M A
authors.initials: MA
authors.lastname: King
authors.forename: E R
authors.initials: ER
authors.lastname: Pacht
authors.forename: M D
authors.initials: MD
authors.lastname: Wewers
authors.forename: J E
authors.initials: JE
authors.lastname: Gadek
authors.forename: H N
authors.initials: HN
authors.lastname: Nagaraja
authors.forename: J
authors.initials: J
authors.lastname: Drake
authors.forename: T L
authors.initials: TL
authors.lastname: Clanton
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004198:Disease Susceptibility; D005260:Female; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000150:complications* / Q000000981:diagnostic imaging / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000209:etiology* / Q000276:immunology; D012129:Respiratory Function Tests; D012907:Smoking / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed