title: Association of COPD With Risk for Pulmonary Infections Requiring Hospitalization in HIV-Infected Veterans.
abstract: BACKGROUND
  Pulmonary infections remain more common in HIV-infected (HIV+) compared with uninfected individuals. The increase in chronic lung diseases among aging HIV+ individuals may contribute to this persistent risk. We sought to determine whether chronic obstructive pulmonary disease (COPD) is an independent risk factor for different pulmonary infections requiring hospitalization among HIV+ patients.
  
  
  METHODS
  We analyzed data from 41,993 HIV+ Veterans in the nationwide Veterans Aging Cohort Study Virtual Cohort from 1996 to 2009. Using International Classification of Diseases, Ninth Revision codes, we identified baseline comorbid conditions, including COPD, and incident community-acquired pneumonia (CAP), pulmonary tuberculosis (TB), and Pneumocystis jirovecii pneumonia (PCP) requiring hospitalization within 2 years after baseline. We used multivariable Poisson regression to determine incidence rate ratios (IRRs) associated with COPD for each type of pulmonary infection, adjusting for comorbidities, CD4 cell count, HIV viral load, smoking status, substance use, vaccinations, and calendar year at baseline.
  
  
  RESULTS
  Unadjusted incidence rates of CAP, TB, and PCP requiring hospitalization were significantly higher among persons with COPD compared to those without COPD (CAP: 53.9 vs. 19.4 per 1000 person-years; TB: 8.7 vs. 2.8; PCP: 15.5 vs. 9.2; P ≤ 0.001). In multivariable Poisson regression models, COPD was independently associated with increased risk of CAP, TB, and PCP (IRR: 1.94, 95% confidence interval [CI]: 1.64 to 2.30; IRR: 2.60, 95% CI: 1.70 to 3.97; and IRR: 1.48, 95% CI: 1.10 to 2.01, respectively).
  
  
  CONCLUSIONS
  COPD is an independent risk factor for CAP, TB, and PCP requiring hospitalization among HIV+ individuals. As the HIV+ population ages, the growing burden of COPD may confer substantial risk for pulmonary infections.
authors.affiliation: *Department of Medicine, University of Washington, Seattle, WA; †Veterans Affairs Connecticut Healthcare System, West Haven, CT; ‡Veterans Affairs Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, WA; §Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT, and Department of Medicine, Yale University School of Medicine, New Haven, CT; ‖Department of Medicine and Veterans Affairs Pittsburgh Healthcare System, University of Pittsburgh School of Medicine, Pittsburgh, PA, and Hamad Medical Corporation, Doha, Qatar; ¶Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, Los Angeles, CA; #Division of General Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; **Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center and Department of Medicine, Baylor College of Medicine, Houston, Texas; ††Department of Medicine, Yale University School of Medicine, New Haven, CT; ‡‡Department of Medicine, Vanderbilt University School of Medicine and Nashville Veterans Affairs Medical Center, Nashville, TN; §§James J. Peters Veterans Affairs Medical Center, Department of Medicine, Bronx and Department of Medicine, Icahn School of Medicine at Mt. Sinai, New York, NY; ‖‖Department of Medicine, Atlanta Veterans Affairs Medical Center and Emory University School of Medicine, Atlanta, GA; ¶¶Department of Medicine, Washington DC Veterans Affairs Medical Center and George Washington University School of Medicine, Washington, DC; and ##Department of Medicine, University of California San Francisco, San Francisco, CA.
authors.forename: Engi F
authors.initials: EF
authors.lastname: Attia
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: McGinnis
authors.forename: Laura C
authors.initials: LC
authors.lastname: Feemster
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Akgün
authors.forename: Adeel A
authors.initials: AA
authors.lastname: Butt
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Graber
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Goetz
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Pisani
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Tindle
authors.forename: Sheldon T
authors.initials: ST
authors.lastname: Brown
authors.forename: Guy W
authors.initials: GW
authors.lastname: Soo Hoo
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Gibert
authors.forename: Laurence
authors.initials: L
authors.lastname: Huang
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Freiberg
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Hough
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
mesh_terms: D000328:Adult; D017714:Community-Acquired Infections; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000150:complications*; D011020:Pneumonia, Pneumocystis / Q000150:complications*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000150:complications*; D014728:Veterans; D019562:Viral Load