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J Acquir Immune Defic Syndr. 2017 Jan 1;74(1):e23-e29.

The Differential Impact of Emphysema on Respiratory Symptoms and 6-Minute Walk Distance in HIV Infection.

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*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.



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.

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