title: The Differential Impact of Emphysema on Respiratory Symptoms and 6-Minute Walk Distance in HIV Infection.
abstract: Emphysema is more prevalent in HIV-infected (HIV+) patients independent of smoking behavior. Nonetheless, health effects of emphysema in this population are poorly understood. We determined whether emphysema is associated with a greater burden of pulmonary symptoms and a lower 6-minute walk distance (6MWD) in HIV+ compared with HIV-uninfected (HIV-) subjects.
  
  
  
  We performed a cross-sectional analysis of 170 HIV+ and 153 HIV- subjects in the Examinations of HIV-Associated Lung Emphysema (EXHALE) cohort study. Subjects completed a self-assessment of respiratory symptoms, pulmonary function testing, and 6MWD testing as well as a chest computed tomography to determine emphysema severity. We used regression models to determine the association of emphysema with respiratory symptoms and 6MWD in HIV+ subjects and compared this to HIV- subjects.
  
  
  
  Models stratified by HIV status demonstrated an association between >10% radiographic emphysema and chronic cough and/or phlegm and 6MWD in HIV+ subjects. These associations persisted among the subset without airflow obstruction: those with emphysema had 4.2 (95% confidence interval: 1.3 to 14) times the odds of chronic cough and/or phlegm and walked 60 m (95% confidence interval: 26 to 93) less distance than those without emphysema. There was no association between >10% emphysema and symptoms or 6MWD in HIV- subjects.
  
  
  
  In our cohort, >10% radiographic emphysema was associated with chronic cough and/or phlegm and lower 6MWD in HIV+ but not HIV- subjects. These findings were robust even among HIV+ subjects with milder forms of emphysema and those without airflow obstruction, highlighting the clinical impact of emphysema in these patients.
authors.affiliation: *Department of Medicine, University of Washington, Seattle, WA; †Department of Internal Medicine, Veterans Affairs Connecticut Healthcare System, Yale University School of Medicine, New Haven, CT; ‡Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX; §Department of Radiology, University of Washington, Seattle, WA; ‖Department of Medicine, Atlanta Veterans Affairs Medical Center, Emory University School of Medicine, Atlanta, GA; ¶Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA; #Department of Medicine, James J. Peters Veterans Affairs Medical Center, Bronx, NY; and **Department of Medicine, Icahn School of Medicine at Mt. Sinai, New York, NY.
authors.forename: Matthew
authors.initials: M
authors.lastname: Triplette
authors.forename: Engi
authors.initials: E
authors.lastname: Attia
authors.forename: Kathleen
authors.initials: K
authors.lastname: Akgün
authors.forename: Monica
authors.initials: M
authors.lastname: Campo
authors.forename: Maria
authors.initials: M
authors.lastname: Rodriguez-Barradas
authors.forename: Sudhakar
authors.initials: S
authors.lastname: Pipavath
authors.forename: Shahida
authors.initials: S
authors.lastname: Shahrir
authors.forename: Cherry
authors.initials: C
authors.lastname: Wongtrakool
authors.forename: Matthew
authors.initials: M
authors.lastname: Goetz
authors.forename: Joon
authors.initials: J
authors.lastname: Kim
authors.forename: Guy W
authors.initials: GW
authors.lastname: Soo Hoo
authors.forename: Sheldon T
authors.initials: ST
authors.lastname: Brown
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
mesh_terms: D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004646:Emphysema / Q000150:complications*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D047908:Intracellular Signaling Peptides and Proteins; D008124:Locomotion; D008297:Male; D008875:Middle Aged; D011506:Proteins; D012131:Respiratory Insufficiency / Q000473:pathology*
chemical_list: C484600:IMPACT protein, human; D047908:Intracellular Signaling Peptides and Proteins; D011506:Proteins