title: Will expanded ART use reduce the burden of HIV-associated chronic lung disease?
abstract: OBJECTIVE
  The pulmonary complications of chronic HIV infection have shifted from infectious complications toward noninfectious pulmonary complications, predominantly chronic obstructive pulmonary disease (COPD). Although the best-established COPD risk factor is cigarette smoking, emerging data suggest that HIV infection also independently increases COPD risk. The purpose of this article is to review these data and the conflicting data regarding the role of antiretroviral therapy (ART) in modifying COPD risk.
  
  
  RESULTS
  Observational studies favor HIV as an independent risk factor for COPD, particularly when viral load is high. The mechanisms underlying these associations are unclear, but untreated HIV infection is associated with pulmonary inflammatory responses similar to those seen in non-HIV COPD. ART reduces this pulmonary inflammation, but the clinical benefit of such reduction is unknown. Some observational studies suggest that ART users are at lower risk of COPD, whereas other studies suggest the opposite scenario.
  
  
  CONCLUSIONS
  The effect of ART in causing COPD or reducing COPD risk is unknown, but is currently being tested in a randomized trial. Smoking cessation should remain of high priority.
authors.affiliation: aSection of Pulmonary, Critical Care, and Sleep Apnea, Minneapolis Veterans Affairs Healthcare System bDivision of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Ken M
authors.initials: KM
authors.lastname: Kunisaki
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000453:epidemiology; D012306:Risk
chemical_list: D044966:Anti-Retroviral Agents