Increased susceptibility to pulmonary emphysema among HIV-seropositive smokers.
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.
Diaz
P T
PT
Department of Internal Medicine, Ohio State University, Columbus 43210, USA.
King
M A
MA
Pacht
E R
ER
Wewers
M D
MD
Gadek
J E
JE
Nagaraja
H N
HN
Drake
J
J
Clanton
T L
TL
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