title: Risk factors associated with acute exacerbation of chronic obstructive pulmonary disease in HIV-infected and uninfected patients.
abstract: OBJECTIVE
  To determine the association between HIV infection and other risk factors for acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
  
  
  METHODS
  Longitudinal, national Veterans Aging Cohort Study including 43 618 HIV-infected and 86 492 uninfected veterans.
  
  
  METHODS
  AECOPD was defined as an inpatient or outpatient COPD ICD-9 diagnosis accompanied by steroid and/or antibiotic prescription within 5 days. We calculated incidence rate ratios (IRR) and 95% confidence intervals (CI) for first AECOPD over 2 years and used Poisson regression models to adjust for risk factors.
  
  
  RESULTS
  Over 234 099 person-years of follow-up, 1428 HIV-infected and 2104 uninfected patients had at least one AECOPD. HIV-infected patients had an increased rate of AECOPD compared with uninfected (18.8 vs. 13.3 per 1000 person-years, P < 0.001). In adjusted models, AECOPD risk was greater in HIV-infected individuals overall (IRR 1.54; 95% CI 1.44-1.65), particularly in those with more severe immune suppression when stratified by CD4 cell count (cells/μl) compared with uninfected (HIV-infected CD4 < 200: IRR 2.30, 95% CI 2.10-2.53, HIV-infected CD4 ≥ 200-349: IRR 1.32, 95% CI 1.15-1.51, HIV-infected CD4 ≥ 350: IRR 0.99, 95% CI 0.88-1.10). HIV infection also modified the association between current smoking and alcohol-related diagnoses with risk for AECOPD such that interaction terms for HIV and current smoking or HIV and alcohol-related diagnoses were each significantly associated with AECOPD.
  
  
  CONCLUSIONS
  HIV infection, especially with lower CD4 cell count, is an independent risk factor for AECOPD. Enhanced susceptibility to harm from current smoking or unhealthy alcohol use in HIV-infected patients may also contribute to the greater rate of AECOPD.
authors.affiliation: aUniversity of South Carolina, Columbia, South CarolinabVA Pittsburgh Healthcare SystemcUniversity of Pittsburgh School of Medicine, Pittsburgh, PennsylvaniadVA Connecticut Healthcare System, West HaveneYale University School of Medicine, New Haven, ConnecticutfHamad Healthcare Quality Institute and Hamad Medical Corporation, Doha, QatargRutgers University, New Brunswick, New JerseyhVanderbilt University Medical Center, Nashville, TennesseeiWashington DC VA Medical Center, Washington, District of ColumbiajVA Medical Center and Emory University School of Medicine, Atlanta, GeorgiakNational Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MarylandlUniversity of Washington, Seattle, Washington, USA.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Depp
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: McGinnis
authors.forename: Kevin
authors.initials: K
authors.lastname: Kraemer
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Akgün
authors.forename: E Jennifer
authors.initials: EJ
authors.lastname: Edelman
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.forename: Adeel A
authors.initials: AA
authors.lastname: Butt
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
authors.forename: Matthew
authors.initials: M
authors.lastname: Freiberg
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Gibert
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Kendall J
authors.initials: KJ
authors.lastname: Bryant
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects