title: HIV and COPD: impact of risk behaviors and diseases on quality of life.
abstract: OBJECTIVE
  Smoking worsens quality of life among HIV-infected individuals, but it remains unclear if this association is related simply to smoking or to chronic obstructive pulmonary disease (COPD), the end-organ disease caused by smoking.
  
  
  METHODS
  Using cross-sectional data from the AIDS Linked to the Intravenous Experience study, we determined the independent effects of smoking, HIV and COPD assessed using the Medical Outcome Studies-HIV questionnaire.
  
  
  RESULTS
  Of 973 participants, 287 (29.5%) were HIV infected and 151 (15.5%) had spirometry-defined obstruction. Eight hundred and thirty-four (85.7%) were current smokers with 23.3 mean pack-years history. HIV infection was independently associated with reduced physical and mental health. COPD was associated with a trend toward worse physical health (-1.48 units; 95%CI -3.33 to 0.38; p = 0.12) and was independently associated with worse mental health (-2.43 units; 95%CI -4.22 to -0.64; p < 0.01). After accounting for COPD and other covariates, smoking was not associated with changes in physical or mental health.
  
  
  CONCLUSIONS
  The presence of COPD, rather than smoking, is associated with worse quality of life independent of HIV infection. Diagnosis and management of COPD in former or current smokers with or at risk for HIV may further improve quality of life.
authors.affiliation: Department of Medicine, School of Medicine, Johns Hopkins University, 5501 Hopkins Bayview Circle, JHAAC 4B.70, Baltimore, MD 21224, USA. mdrummo3@jhmi.edu
authors.forename: M Bradley
authors.initials: MB
authors.lastname: Drummond
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kirk
authors.forename: Meredith C
authors.initials: MC
authors.lastname: McCormack
authors.forename: Mariah M
authors.initials: MM
authors.lastname: Marshall
authors.forename: Erin P
authors.initials: EP
authors.lastname: Ricketts
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wise
authors.forename: Christian A
authors.initials: CA
authors.lastname: Merlo
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000523:psychology*; D011788:Quality of Life; D012309:Risk-Taking