Matthew Triplette1, Engi Attia, Kathleen Akgün, Monica Campo, Maria Rodriguez-Barradas, Sudhakar Pipavath, Shahida Shahrir, Cherry Wongtrakool, Matthew Goetz, Joon Kim, Guy W Soo Hoo, Sheldon T Brown, Kristina Crothers. 1. *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.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Kristina Crothers; Bruce W Thompson; Kathryn Burkhardt; Alison Morris; Sonia C Flores; Philip T Diaz; Richard E Chaisson; Gregory D Kirk; William N Rom; Laurence Huang Journal: Proc Am Thorac Soc Date: 2011-06
Authors: Jessica Bon; Carl R Fuhrman; Joel L Weissfeld; Steven R Duncan; Robert A Branch; Chung-Chou H Chang; Yingze Zhang; Joseph K Leader; David Gur; Susan L Greenspan; Frank C Sciurba Journal: Am J Respir Crit Care Med Date: 2010-10-08 Impact factor: 21.405
Authors: Amy C Justice; Elizabeth Dombrowski; Joseph Conigliaro; Shawn L Fultz; Deborah Gibson; Tamra Madenwald; Joseph Goulet; Michael Simberkoff; Adeel A Butt; David Rimland; Maria C Rodriguez-Barradas; Cynthia L Gibert; Kris Ann K Oursler; Sheldon Brown; David A Leaf; Matthew B Goetz; Kendall Bryant Journal: Med Care Date: 2006-08 Impact factor: 2.983
Authors: Matthew Triplette; Amy Justice; Engi F Attia; Janet Tate; Sheldon T Brown; Matthew Bidwell Goetz; Joon W Kim; Maria C Rodriguez-Barradas; Guy W Soo Hoo; Cherry Wongtrakool; Kathleen Akgün; Kristina Crothers Journal: AIDS Date: 2018-02-20 Impact factor: 4.177
Authors: Matthew Triplette; Keith M Sigel; Alison Morris; Shahida Shahrir; Juan P Wisnivesky; Chung Y Kong; Phillip T Diaz; Alycia Petraglia; Kristina Crothers Journal: AIDS Date: 2017-07-31 Impact factor: 4.177
Authors: Matthew Triplette; Engi F Attia; Kathleen M Akgün; Guy W Soo Hoo; Matthew S Freiberg; Adeel A Butt; Cherry Wongtrakool; Matthew Bidwell Goetz; Sheldon T Brown; Christopher J Graber; Laurence Huang; Kristina Crothers Journal: PLoS One Date: 2017-01-25 Impact factor: 3.240
Authors: Tom E Robertson; Mehdi Nouraie; Shulin Qin; Kristina A Crothers; Cathy J Kessinger; Deborah McMahon; Divay Chandra; Lawrence A Kingsley; Ruth M Greenblatt; Laurence Huang; Meghan E Fitzpatrick; Alison Morris Journal: PLoS One Date: 2019-04-24 Impact factor: 3.240
Authors: Rebekka F Thudium; Hedda Ringheim; Andreas Ronit; Hedda Hoel; Thomas Benfield; Amanda Mocroft; Jan Gerstoft; Marius Trøseid; Álvaro H Borges; Sisse R Ostrowski; Jørgen Vestbo; Susanne D Nielsen Journal: Front Immunol Date: 2021-04-14 Impact factor: 7.561
Authors: Jerry S Zifodya; Matthew Triplette; Shahida Shahrir; Engi F Attia; Kathleen M Akgun; Grant W Soo Hoo; Maria C Rodriguez-Barradas; Cherry Wongtrakool; Laurence Huang; Kristina Crothers Journal: Medicine (Baltimore) Date: 2021-09-17 Impact factor: 1.889