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AIDS. 2016 Jan 28;30(3):455-63. doi: 10.1097/QAD.0000000000000940.

Risk factors associated with acute exacerbation of chronic obstructive pulmonary disease in HIV-infected and uninfected patients.

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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.



To determine the association between HIV infection and other risk factors for acute exacerbation of chronic obstructive pulmonary disease (AECOPD).


Longitudinal, national Veterans Aging Cohort Study including 43 618 HIV-infected and 86 492 uninfected veterans.


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.


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.


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.

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