B27 HIV BENCH TO BEDSIDE: TUBERCULOSIS AND OTHER PULMONARY COMPLICATIONS / Poster Discussion Session / Monday, May 22/9:15

AM-11:15 AM / Room 144 A-C (Middle

Building, Street Level) Walter E. Washington Convention Center

Association Between COPD And Mortality For Hiv-Infected And Uninfected Veterans Hospitalized With
Community-Acquired Pneumonia

E. F. Attia1, K. A. McGinnis2, L. C. Feemster3, M. A. Pisani4, A. A. Butt5, K. M. Akgun6, L. Huang7, C. L. Gibert8, G. W. Soo Hoo9, M.
B. Goetz9, D. Rimland10, K. Crothers1
1University of Washington, Seattle, WA, 2Veterans Affairs Connecticut Healthcare System, West Haven, CT, 3VA Puget Sound HealthCare

System HSR&D; University of Washington, Seattle, WA, 4Yale University School of Medicine, New Haven, CT, 5Veterans Affairs Pittsburgh
Healthcare System; University of Pittsburgh School of Medicine, Pittsburgh, PA, 6Veterans Affairs Connecticut Healthcare System; Yale
University School of Medicine, West Haven, CT, 7University of California San Francisco, San Francisco, CA, 8Washington DC Veterans Affairs
Medical Center; George Washington University School of Medicine, Washington, DC, 9Veterans Affairs Greater Los Angeles Healthcare
System and David Geffen School of Medicine at UCLA, Los Angeles, CA, 10Atlanta Veterans Affairs Medical; Emory University School of
Medicine, Decatur, GA

Corresponding author's email: eattia@uw.edu

Rationale
COPD is a risk factor for community-acquired pneumonia (CAP) in both HIV-infected (HIV+) and uninfected (HIV-) individuals. However,
few studies have examined the impact of COPD on outcomes of CAP in HIV. We determined whether COPD is associated with greater
mortality from hospitalized CAP, and whether this differs by HIV status.
Methods
Among 47,805 HIV+ and 99,060 HIV- Veterans in the Veterans Aging Cohort Study (VACS), a nationwide cohort of HIV+ and HIV- patients
matched by age, race/ethnicity, sex, and site-of-care, we identified 6,094 HIV+ and 3,697 HIV- patients hospitalized with CAP (1997-2010).
HIV, COPD, and CAP hospitalization were identified using ICD-9 codes. Thirty-day and 1-year mortality after admission were calculated per
100 person-years by HIV and COPD. Cox proportional hazard models assessed associations of HIV and COPD with mortality; multivariable
models were adjusted for age, race/ethnicity, sex, smoking, admission year, and hepatitis C infection (HCV).
Results
Compared to HIV- patients, those with HIV were younger (mean age at hospitalization 52 vs. 57 years), more likely to be African-American
(58% vs. 52%), more likely to have HCV (49% vs. 25%), and less likely to have COPD (29% vs. 42%). Overall, 55% were current smokers; this
did not differ by HIV status. Of the HIV+ and HIV-, 791 (13%) and 422 (11%) died within 30 days of admission (incidence rate [IR]=171 vs.
148, p=0.02). Among the HIV+, IR was similar for those with and without COPD (IR=173 vs. 170, p=0.9); for the HIV-, IR was higher for those
with COPD (IR=170 vs. 133; p=0.01). In adjusted models, HIV, but not COPD, was significantly associated with 30-day mortality (Table). For
1-year mortality, 2133 HIV+ (35%) and 1162 HIV- (31%) individuals died (IR=47 vs. 41, p<0.001). Among both groups, IR was higher for
those with COPD than without COPD (IR=55 vs. 44 for HIV+, p<0.001; 51 vs. 35 for HIV-, p<0.001). In adjusted models, both COPD and HIV
were significantly associated with 1-year mortality. There was no statistically significant interaction between HIV and COPD for 30-day or
1-year mortality.
Conclusions
HIV and COPD are associated with increased mortality after CAP hospitalization. COPD was more strongly associated with 1-year mortality,
while HIV was associated with both 1-year and shorter-term mortality. COPD may be an important driver of longer-term outcomes of CAP
in HIV+ and HIV- patients. Future analyses require consideration of the role of severity of CAP, COPD, and other comorbidities on
outcomes.
This abstract is funded by: R01 HL090342, U24-AA020794
Am J Respir Crit Care Med 2017;195:A3079
Internet address: www.atsjournals.org Online Abstracts Issue