Emphysema Distribution and Diffusion Capacity Predict Emphysema Progression in Human Immunodeficiency Virus Infection

• Published in: PloS one 2016-11, Vol.11 (11), p.e0167247-e0167247
• Main Authors: Leung, Janice M, Malagoli, Andrea, Santoro, Antonella, Besutti, Giulia, Ligabue, Guido, Scaglioni, Riccardo, Dai, Darlene, Hague, Cameron, Leipsic, Jonathon, Sin, Don D, Man, Sf Paul, Guaraldi, Giovanni
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Airway management; Biology and Life Sciences; Carbon monoxide; Chronic infection; Chronic obstructive pulmonary disease; Cohort Studies; Complications and side effects; Computed tomography; Confidence intervals; Development and progression; Diffusion; Disease Progression; Emphysema; Emphysema - complications; Emphysema - diagnosis; Emphysema - diagnostic imaging; Emphysema - pathology; Female; Heart; HIV; HIV infections; HIV Infections - complications; Hospitals; Human immunodeficiency virus; Humans; Infections; Lentivirus; Logistic Models; Lung diseases; Male; Medical imaging; Medicine; Medicine and Health Sciences; Metabolism; Middle Aged; Obstructive lung disease; Patients; Physical Sciences; Population; Prognosis; Radiology; Regression analysis; Regression models; Research and Analysis Methods; Retroviridae; ROC Curve; Senescence; Statistical analysis; Studies; Tomography, X-Ray Computed; Viruses
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0167247

Chronic obstructive pulmonary disease (COPD) and emphysema are common amongst patients with human immunodeficiency virus (HIV). We sought to determine the clinical factors that are associated with emphysema progression in HIV. 345 HIV-infected patients enrolled in an outpatient HIV metabolic clinic with ≥2 chest computed tomography scans made up the study cohort. Images were qualitatively scored for emphysema based on percentage involvement of the lung. Emphysema progression was defined as any increase in emphysema score over the study period. Univariate analyses of clinical, respiratory, and laboratory data, as well as multivariable logistic regression models, were performed to determine clinical features significantly associated with emphysema progression. 17.4% of the cohort were emphysema progressors. Emphysema progression was most strongly associated with having a low baseline diffusion capacity of carbon monoxide (DLCO) and having combination centrilobular and paraseptal emphysema distribution. In adjusted models, the odds ratio (OR) for emphysema progression for every 10% increase in DLCO percent predicted was 0.58 (95% confidence interval [CI] 0.41-0.81). The equivalent OR (95% CI) for centrilobular and paraseptal emphysema distribution was 10.60 (2.93-48.98). Together, these variables had an area under the curve (AUC) statistic of 0.85 for predicting emphysema progression. This was an improvement over the performance of spirometry (forced expiratory volume in 1 second to forced vital capacity ratio), which predicted emphysema progression with an AUC of only 0.65. Combined paraseptal and centrilobular emphysema distribution and low DLCO could identify HIV patients who may experience emphysema progression.