Increased susceptibility to pulmonary emphysema among HIV-seropositive smokers

Ann Intern Med. 2000 Mar 7;132(5):369-72. doi: 10.7326/0003-4819-132-5-200003070-00006.


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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Analysis of Variance
  • CD4 Lymphocyte Count
  • Case-Control Studies
  • Cross-Sectional Studies
  • Disease Susceptibility
  • Female
  • HIV Seronegativity
  • HIV Seropositivity / complications*
  • HIV Seropositivity / diagnostic imaging
  • HIV Seropositivity / immunology
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Pulmonary Emphysema / diagnostic imaging
  • Pulmonary Emphysema / etiology*
  • Pulmonary Emphysema / immunology
  • Respiratory Function Tests
  • Smoking / adverse effects*
  • Tomography, X-Ray Computed