title: Emphysema Distribution and Diffusion Capacity Predict Emphysema Progression in Human Immunodeficiency Virus Infection.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) and emphysema are common amongst patients with human immunodeficiency virus (HIV). We sought to determine the clinical factors that are associated with emphysema progression in HIV.
  
  
  METHODS
  345 HIV-infected patients enrolled in an outpatient HIV metabolic clinic with ≥2 chest computed tomography scans made up the study cohort. Images were qualitatively scored for emphysema based on percentage involvement of the lung. Emphysema progression was defined as any increase in emphysema score over the study period. Univariate analyses of clinical, respiratory, and laboratory data, as well as multivariable logistic regression models, were performed to determine clinical features significantly associated with emphysema progression.
  
  
  RESULTS
  17.4% of the cohort were emphysema progressors. Emphysema progression was most strongly associated with having a low baseline diffusion capacity of carbon monoxide (DLCO) and having combination centrilobular and paraseptal emphysema distribution. In adjusted models, the odds ratio (OR) for emphysema progression for every 10% increase in DLCO percent predicted was 0.58 (95% confidence interval [CI] 0.41-0.81). The equivalent OR (95% CI) for centrilobular and paraseptal emphysema distribution was 10.60 (2.93-48.98). Together, these variables had an area under the curve (AUC) statistic of 0.85 for predicting emphysema progression. This was an improvement over the performance of spirometry (forced expiratory volume in 1 second to forced vital capacity ratio), which predicted emphysema progression with an AUC of only 0.65.
  
  
  CONCLUSIONS
  Combined paraseptal and centrilobular emphysema distribution and low DLCO could identify HIV patients who may experience emphysema progression.
authors.affiliation: Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC.|Division of Respiratory Medicine, Department of Medicine, St. Paul's Hospital, Vancouver, BC.
authors.forename: Janice M
authors.initials: JM
authors.lastname: Leung
authors.affiliation: Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Malagoli
authors.affiliation: Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Santoro
authors.affiliation: Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Besutti
authors.affiliation: Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Ligabue
authors.affiliation: Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Scaglioni
authors.affiliation: PROOF Centre for Excellence, University of British Columbia, Vancouver, BC.
authors.forename: Darlene
authors.initials: D
authors.lastname: Dai
authors.affiliation: Department of Radiology, University of British Columbia, Vancouver, Canada.
authors.forename: Cameron
authors.initials: C
authors.lastname: Hague
authors.affiliation: Department of Radiology, University of British Columbia, Vancouver, Canada.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC.|Division of Respiratory Medicine, Department of Medicine, St. Paul's Hospital, Vancouver, BC.
authors.forename: Don D
authors.initials: DD
authors.lastname: Sin
authors.affiliation: Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC.|Division of Respiratory Medicine, Department of Medicine, St. Paul's Hospital, Vancouver, BC.
authors.forename: Sf Paul
authors.initials: SP
authors.lastname: Man
authors.affiliation: Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Guaraldi
mesh_terms: D015331:Cohort Studies; D004058:Diffusion; D018450:Disease Progression; D004646:Emphysema / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D014057:Tomography, X-Ray Computed