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Increased Susceptibility to Pulmonary Emphysema among HIV-Seropositive Smokers

Philip T. Diaz, MD; Mark A. King, MD; Eric R. Pacht, MD; Mark D. Wewers, MD; James E. Gadek, MD; Haikady N. Nagaraja, PhD; Janice Drake; and Thomas L. Clanton, PhD
[+] Article, Author, and Disclosure Information

From Ohio State University, Columbus, Ohio.

Acknowledgments: The authors thank Tina Bees and Valerie Wright for assistance in manuscript preparation.

Grant Support: By National Heart, Lung, and Blood Institute grants RO1-HL49730 and RO1HL53229 and by Clinical Research Center Grant 2MO1-RR0034.

Requests for Single Reprints: Philip T. Diaz, MD, Pulmonary and Critical Care Medicine, North 325 Means Hall, 1654 Upham Drive, Columbus, OH 43210-1228.

Requests To Purchase Bulk Reprints (minimum, 100 copies): Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Drs. Diaz, Pacht, Wewers, Gadek, Drake, and Clanton: Pulmonary and Critical Care Division, Department of Internal Medicine, Ohio State University, N-325 Means Hall, 1654 Upham Drive, Columbus, OH 43210.

Dr. King: Department of Radiology, Ohio State University, N-325 Means Hall, 1654 Upham Drive, Columbus, OH 43210.

Dr. Nagaraja: Department of Statistics, Ohio State University, N-325 Means Hall, 1654 Upham Drive, Columbus, OH 43210.

Author Contributions: Conception and design: P.T. Diaz, M.A. King, E.R. Pacht, M.D. Wewers, J.E. Gadek, J. Drake, T.L. Clanton.

Analysis and interpretation of data: P.T. Diaz, M.A. King, E.R. Pacht, J.E. Gadek, H.N. Nagaraja, T.L. Clanton.

Drafting of the article: P.T. Diaz.

Critical revision of the article for important intellectual content: P.T. Diaz, M.A. King, M.D. Wewers, J.E. Gadek, H.N. Nagaraja, T.L. Clanton.

Final approval of the article: P.T. Diaz, M.A. King, E.R. Pacht, M.D. Wewers, J.E. Gadek, H.N. Nagaraja, J. Drake, T.L. Clanton.

Provision of study materials or patients: P.T. Diaz.

Statistical expertise: H.N. Nagaraja, T.L. Clanton.

Obtaining of funding: P.T. Diaz, M.D. Wewers.

Administrative, technical, or logistic support: P.T. Diaz.

Collection and assembly of data: M.A. King, J. Drake.

Ann Intern Med. 2000;132(5):369-372. doi:10.7326/0003-4819-132-5-200003070-00006
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Background: Previous uncontrolled reports have suggested that HIV-seropositive persons develop an accelerated form of emphysema.

Objective: To characterize the risk for emphysema in a stable HIV-seropositive outpatient population.

Design: Controlled, cross-sectional analysis.

Setting: Midwestern urban community.

Participants: HIV-seropositive persons (n = 114) without AIDS-related pulmonary complications and HIV-seronegative controls (n = 44), matched for age and smoking history.

Measurements: Measurement of pulmonary function, bronchoalveolar lavage, and high-resolution computed tomography of the chest.

Results: The incidence of emphysema was 15% (17 of 114) in the HIV-seropositive group compared with 2% (1 of 44) in the HIV-seronegative group (P = 0.025). The incidence of emphysema in participants with a smoking history of 12 pack-years or greater was 37% (14 of 38 persons) in the HIV-seropositive group compared with 0% (0 of 14 persons) in the HIV-seronegative group (P = 0.011). The percentage of cytotoxic lymphocytes in lavage fluid was much higher in HIV-seropositive smokers with emphysema.

Conclusions: Infection with HIV accelerates the onset of smoking-induced emphysema. The results of this study support the emerging concept that cytotoxic lymphocytes may have an important role in emphysema pathogenesis.


Grahic Jump Location
High-resolution computed tomographic scans of the chest. A.3arrowsB.3

An HIV-seropositive person (CD4 count, 522 cells/mm ) with emphysema, identified by coalescing avascular areas indicative of parenchymal lung destruction ( ). The person's age (34 years) and smoking history (16 pack-years) are consistent with a precocious process. Total emphysema profusion score = 10. Frank bullous lung destruction in a 30-year-old HIV-seropositive patient (CD4 count, 45 cells/mm ) with a 9-pack-year history of cigarette smoking. Total emphysema profusion score = 17.

Grahic Jump Location




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Summary for Patients

HIV Infection and Emphysema

The summary below is from the full report titled “Increased Susceptibility to Pulmonary Emphysema among HIV-Seropositive Smokers.”. It is in the 7 March 2000 issue of Annals of Internal Medicine (volume 132, pages 369-372). The authors are P.T. Diaz, M.A. King, E.R. Pacht, M.D. Wewers, J.E. Gadek, H.N. Nagaraja, J. Drake, and T.L. Clanton.


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