title: The burden of image based emphysema and bronchiolitis in HIV-infected individuals on antiretroviral therapy.
abstract: BACKGROUND
  With the widespread use of anti-retroviral therapy (ART), individuals infected with human immune deficiency virus (HIV) are increasingly experiencing morbidity and mortality from respiratory disorders. However, the prevalence or the risk factors associated with emphysema and bronchiolitis are largely unknown.
  
  
  METHODS
  Thoracic computed tomography (CT) scans were performed in 1,446 patients infected with HIV who were on ART and who attended a tertiary care metabolic clinic (average age 48 years and 29% females). Detailed history and physical examination including anthropometric measurements were performed. Complete pulmonary function tests were performed in a subset of these patients (n = 364). No subjects were acutely ill with a respiratory condition at the time of CT scanning.
  
  
  RESULTS
  Nearly 50% of the subjects had CT evidence for emphysema, bronchiolitis or both with 13% (n = 195) showing bronchiolitis, 19% (n = 274) showing emphysema and 16% (n = 238) revealing both. These phenotypes were synergistically associated with reduced regular physical activity (p for interaction <.0001). The most significant risk factors for both phenotypes were cigarette smoking, intravenous drug use and peripheral leucocytosis. Together, the area-under-the curve statistics was 0.713 (p = 0.0037) for discriminating those with and without these phenotypes. There were no significant changes in lung volumes or flow rates related to these phenotypes, though the carbon monoxide diffusion capacity was reduced for the emphysema phenotype.
  
  
  CONCLUSIONS
  Emphysema and bronchiolitis are extremely common in HIV-infected patients who are treated with ART and can be identified by use of thoracic CT scanning.
authors.affiliation: Modena and Reggio Emila University, Modena, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Guaraldi
authors.affiliation: Modena and Reggio Emila University, Modena, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Besutti
authors.affiliation: Modena and Reggio Emila University, Modena, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Scaglioni
authors.affiliation: Modena and Reggio Emila University, Modena, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Santoro
authors.affiliation: Modena and Reggio Emila University, Modena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Zona
authors.affiliation: Modena and Reggio Emila University, Modena, Italy.
authors.forename: Ligabue
authors.initials: L
authors.lastname: Guido
authors.affiliation: Modena and Reggio Emila University, Modena, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marchioni
authors.affiliation: Modena and Reggio Emila University, Modena, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Orlando
authors.affiliation: Modena and Reggio Emila University, Modena, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Carli
authors.affiliation: Modena and Reggio Emila University, Modena, Italy.
authors.forename: Bianca
authors.initials: B
authors.lastname: Beghe
authors.affiliation: Modena and Reggio Emila University, Modena, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Fabbri
authors.affiliation: Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: Department of Medicine (Respiratory Division), University of British Columbia, Vancouver, British Columbia, Canada; UBC James Hogg Research Center, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Don D
authors.initials: DD
authors.lastname: Sin
authors.affiliation: Department of Medicine (Respiratory Division), University of British Columbia, Vancouver, British Columbia, Canada; UBC James Hogg Research Center, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: S F Paul
authors.initials: SF
authors.lastname: Man
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D019540:Area Under Curve; D001988:Bronchiolitis / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology; D012129:Respiratory Function Tests; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D044966:Anti-Retroviral Agents