Background: Airflow obstruction, which encompasses several phenotypes, is common among HIV-infected\nindividuals. Obesity and adipose-related inflammation are associated with both COPD (fixed airflow obstruction) and\nasthma (reversible airflow obstruction) in HIV-uninfected persons, but the relationship to airway inflammation and\nairflow obstruction in HIV-infected persons is unknown. The objective of this study was to determine if adiposity\nand adipose-associated inflammation are associated with airway obstruction phenotypes in HIV-infected persons.\nMethods: We performed a cross-sectional analysis of 121 HIV-infected individuals assessed with pulmonary function\ntesting, chest CT scans for measures of airway wall thickness (wall area percent [WA%]) and adipose tissue volumes\n(mediastinal and subcutaneous), as well as HIV- and adipose-related inflammatory markers. Participants were\ndefined as COPD phenotype (post-bronchodilator FEV1/FVC < lower limit of normal) or asthma phenotype (doctordiagnosed\nasthma or bronchodilator response). Pearson correlation coefficients were calculated between adipose\nmeasurements, WA%, and pulmonary function. Multivariable logistic and linear regression models were used to\ndetermine associations of airflow obstruction and airway remodeling (WA%) with adipose measurements and\nparticipant characteristics.\nResults: Twenty-three (19 %) participants were classified as the COPD phenotype and 33 (27 %) were classified as\nthe asthma phenotype. Body mass index (BMI) was similar between those with and without COPD, but higher in\nthose with asthma compared to those without (mean [SD] 30.7 kg/m2 [8.1] vs. 26.5 kg/m2 [5.3], p = 0.008). WA%\ncorrelated with greater BMI (r = 0.55, p < 0.001) and volume of adipose tissue (subcutaneous, r = 0.40; p < 0.001;\nmediastinal, r = 0.25; p = 0.005). Multivariable regression found the COPD phenotype associated with greater age\nand pack-years smoking; the asthma phenotype with younger age, female gender, smoking history, and lower\nadiponectin levels; and greater WA% with greater BMI, younger age, higher soluble CD163, and higher CD4 counts.\nConclusions: Adiposity and adipose-related inflammation are associated with an asthma phenotype, but not a\nCOPD phenotype, of obstructive lung disease in HIV-infected persons. Airway wall thickness is associated with\nadiposity and inflammation. Adipose-related inflammation may play a role in HIV-associated asthma.
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