Increased Susceptibility to Pulmonary Emphysema among HIV-Seropositive Smokers

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Abstract
Previous uncontrolled reports have suggested that HIV-seropositive persons develop an accelerated form of emphysema. To characterize the risk for emphysema in a stable HIV-seropositive outpatient population. Controlled, cross-sectional analysis. Midwestern urban community. HIV-seropositive persons (n = 114) without AIDS-related pulmonary complications and HIV-seronegative controls (n = 44), matched for age and smoking history. Measurement of pulmonary function, bronchoalveolar lavage, and high-resolution computed tomography of the chest. 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. 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.

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