SEATTLE — Pulmonary infections remain more common in patients with human immunodeficiency virus (HIV), compared with those who are uninfected.

Surmising that an increase in chronic lung diseases among aging HIV positive patients could contribute to the risk, a University of Washington-led study involving researchers from 10 VAMCs across the country sought to determine whether chronic obstructive pulmonary disease (COPD) is an independent risk factor for a variety of pulmonary infections requiring hospitalization among that cohort.

For the study published recently in the Journal of Acquired Immune Deficiency Syndrome, researchers analyzed data from 41,993 veterans with HIV in the nationwide Veterans Aging Cohort Study Virtual Cohort from 1996 to 2009. Baseline comorbid conditions, including COPD, and incident community-acquired pneumonia (CAP), pulmonary tuberculosis (TB) and Pneumocystis jirovecii pneumonia (PCP) requiring hospitalization within two years after baseline, were identified.1

Incidence rates then were calculated for each type of pulmonary infection associated with COPD, adjusting for comorbidities, CD4 cell count, HIV viral load, smoking status, substance use and vaccinations.

Results indicate that unadjusted incidence rates of CAP, TB and PCP requiring hospitalization were significantly higher among patients with COPD, compared to those without COPD:

  • CAP: 53.9 vs. 19.4 per 1,000 person-years;
  • TB: 8.7 vs. 2.8;
  • PCP: 15.5 vs. 9.2.

Models suggested that COPD was independently associated with increased risk of CAP, TB and PCP, with incidence rate ratios of 1.94 for CAP, 2.60 for TB and 1.48 for PCP.

“COPD is an independent risk factor for CAP, TB and PCP requiring hospitalization among HIV+ individuals,” study authors concluded. “As the HIV+ population ages, the growing burden of COPD may confer substantial risk for pulmonary infections.”

1 Attia EF, McGinnis KA, Feemster LC, Akgün KM, et. al Association of COPD With Risk for Pulmonary Infections Requiring Hospitalization in HIV-Infected Veterans. J Acquir Immune Defic Syndr. 2015 Nov 1;70(3):280-8.