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J Acquir Immune Defic Syndr. 2014 Apr 15;65(5):557-63. doi: 10.1097/QAI.0000000000000086.

Association of chronic cough and pulmonary function with 6-minute walk test performance in HIV infection.

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*Department of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA; †The Baltimore Veterans Affairs Medical Center, Geriatric Research, Education, and Clinical Center, Baltimore, MD; ‡University of Maryland School of Medicine, Baltimore, MD; §Division of Pulmonary and Critical Care Medicine and HIV/AIDS Division, Department of Medicine, University of California, San Francisco, CA; ‖Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; ¶Department of Medicine, Infectious Diseases Section, University of California-Los Angeles, David Geffen School of Medicine, Los Angeles, CA; #Division of Infectious Diseases, Atlanta Veterans Affairs Medical Center; **Department of Medicine, Emory University School of Medicine, Atlanta, GA; ††Pulmonary and Critical Care Section, West Los Angeles Healthcare Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; ‡‡James J. Peters Veterans Affairs Medical Center; §§Department of Medicine and Infectious Diseases, Icahn School of Medicine at Mount Sinai, Bronx, NY; ‖‖Infectious Diseases Section, Michael E. DeBakey VAMC, Houston, Texas; ¶¶Department of Medicine, Baylor College of Medicine, Houston, Texas; and ##Department of Internal Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT; ***Yale School of Medicine, New Haven, CT.



Chronic lung disease has been associated with greater impairment in self-reported physical function in HIV-infected patients. We sought to study this association using objective measures of physical function and pulmonary function.


Baseline data from the Examinations of HIV Associated Lung Emphysema study, a multicenter observational cohort of HIV-infected and uninfected veterans.


We assessed the association between clinical, laboratory, and pulmonary function measures with 6-minute walk test (6-MWT). Multivariable linear regression models were generated to identify factors associated with 6-MWT performance.


Three hundred forty participants completed 6-MWT (mean age 55 years), with 68% blacks, 94% men, and 62% current smokers. Overall, 180 (53%) were HIV-infected and 63 (19%) had spirometry-defined chronic obstructive pulmonary disease. In a multivariable model, age, current smoking, and obesity (body mass index > 30) were independently associated with lower 6-MWT performance, but HIV infection was not; there was a significant interaction between HIV and chronic cough, such that distance walked among HIV-infected participants with chronic cough was 51.76 m less (P = 0.04) compared with those without cough or HIV. Among HIV-infected participants, the forced expiratory volume in 1 second (FEV1, percent predicted), to a greater extent than total lung capacity or diffusing capacity, attenuated the association with chronic cough; decreased FEV1 was independently associated with lower 6-MWT performance in those with HIV.


Older age, current smoking, and airflow limitation were important determinants of 6-MWT performance in the HIV-infected participants. These findings suggest that potential interventions to improve physical function may include early management of respiratory symptoms and airflow limitation.

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