Yale University

Increased risk of radiographic emphysema in HIV is associated with elevated soluble CD14 and nadir CD4.

TitleIncreased risk of radiographic emphysema in HIV is associated with elevated soluble CD14 and nadir CD4.
Publication TypeJournal Article
Year of Publication2014
AuthorsAttia, Engi F., Kathleen M. Akgün, Cherry Wongtrakool, Matthew Bidwell Goetz, Maria C. Rodriguez-Barradas, David Rimland, Sheldon T. Brown, Guy W. Soo Hoo, Joon Kim, Patty J. Lee, Lynn M. Schnapp, Amir Sharafkhaneh, Amy Justice, and Kristina Crothers
Date Published2014 Jul 31
AbstractBackground:The association between HIV and emphysema remains incompletely understood. We sought to determine whether HIV is an independent risk factor for emphysema severity and whether markers of HIV severity and systemic biomarkers of inflammation (interleukin-6), altered coagulation (D-dimer) and immune activation (soluble CD14) are associated with emphysema. Methods:We performed a cross-sectional analysis of 114 HIV-infected and 89 HIV-uninfected participants in the Examinations of HIV-Associated Lung Emphysema study. Subjects underwent chest CT with blinded semi-quantitative interpretation of emphysema severity, distribution and type. We generated multivariable logistic regression models to determine the risk of HIV for radiographic emphysema, defined as >10% lung involvement. Similar analyses examined associations of plasma biomarkers, HIV RNA, and recent and nadir CD4 cell counts with emphysema among HIV-infected subjects. Results:HIV-infected individuals had greater radiographic emphysema severity with increased lower lung zone and diffuse involvement. HIV was associated with significantly increased risk for >10% emphysema in analyses adjusted for cigarette smoking pack-years (OR 2.24; 95% CI, 1.12 - 4.48). In multivariable analyses restricted to HIV-infected individuals, nadir CD4 <200 (OR 2.98; 95% CI, 1.14 - 7.81) and high soluble CD14 (upper 25th percentile) (OR 2.55; 95% CI, 1.04 - 6.22) were associated with increased risk of >10% emphysema. Interleukin-6 and D-dimer were not associated with emphysema in HIV. Conclusions:HIV is an independent risk factor for radiographic emphysema. Emphysema severity was significantly greater among HIV-infected individuals. Among those with HIV, nadir CD4 <200 and elevated soluble CD14 were associated with emphysema, highlighting potential mechanisms linking HIV with emphysema.
Alternate JournalChest

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