Longitudinal Evaluation of HIV-associated Lung Disease Phenotypes
Condition: Chronic Obstructive Pulmonary Disease; HIV; Emphysema
MeSH terms: Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive; Emphysema
Study type: Observational

Summary: 
      The overall hypotheses of this proposal are that discrete phenotypes of HIV Chronic
      Obstructive Pulmonary disease (COPD) differ in their trajectories, biomarkers, and risk
      factors and that persistent viral infection including residual HIV is linked to HIV COPD.
    

Detailed description: 
      The study is a multicenter, prospective observational study of pathogenesis of HIV pulmonary
      disease. We will determine the prevalence and risk factors for lung dysfunction as quantified
      by pulmonary function testing in HIV+ subjects. We will build on our existing longitudinal
      cohorts while adjusting for important co-variates such as antiretroviral therapy (ART),
      smoking history, co-infections, and illicit drug use. Evaluations will be scheduled at
      baseline, 18 months, and 36 months. (6, 12, 18 and 36 months for ART initiators at the UCSF).
      Study visits will consist of blood draw, questionnaires, pulmonary function testing, 6-minute
      walk test, CT of the chest at visit two. Oral specimen collection and glycocalyx and
      echocardiogram (visit two) at the Pittsburgh site only.
    

Intervention name(s): blood draw; questionnaires; Lung function testing; Six-Minute walk test; Quantitative CT scans; Nasal secretion and cell collection; Echocardiogram
Intervention type(s): Procedure; Procedure; Procedure; Procedure; Radiation; Procedure; Procedure
Intervention description(s): Blood will be drawn for plasma, serum, and PBMCs. Clinical labs drawn will be for hepatitis, CMV, hemoglobin and carboxyhemoglobin.; The following questionnaires are administered to participants by study personnel at each visit: LEAP questionnaire, St. George's, and MMRC.; The routine lung function endpoints of FVC, FEV1, FEV1/FVC, and FEF25-75% will be measured before and after bronchodilator administration (4 puffs of albuterol). The best of three reproducible forced expiratory attempts is used in analysis. Percent- predicted spirometric values are based on age, height, gender, and ethnicity. DLco will be measured using the automated single-breath procedure of the integrated testing system, which conforms to ATS standards. DLco will be adjusted for hemoglobin and carboxyhemoglobin.; Six-minute walk tests are performed in a 100 foot (30.48 m) segment of straight hallway marked at 10 foot (3 m) intervals. In addition to the usual ATS protocol, the patient is monitored, when available, with Bluetooth wireless pulse oximetry and the time and distance recorded after six minutes and if they desaturate to <88%. Dyspnea (Borg 0-10) and perceived exertion (Borg 6-20) scales are completed at the beginning and the end of test.; Subjects will undergo a standard chest CT. The CT scans will use a phantom shipped between sites to standardize results and capture contiguous volume scans acquired at slice thicknesses of 5.0 mm in the axial plane and reconstructed with 512 x 512 pixel matrices. CT examinations will encompass the entire thorax and be performed during a breath-hold at end-inspiration. We will measure % of lung tissue below a threshold for emphysema (i.e. -950 Hounsfield units). Measurements have been histologically-verified and give reproducible measurements. The data set is assembled and analyzed with the image data anonymized.; Participants will be instructed to blow their nose to remove accumulated mucus. Two sprays of commercially available nasal saline will be instilled in each nostril. The participant will then be ask to exhale through the rinsed nostril into a specimen cup. We will repeat this up to 5 times on each side depending on the participants' tolerance to the procedure. Using an otoscope, a small curette will then be used to collect 3 to 5 samples of nasal cells from each nostril. These samples will be used immediately for analysis or banked for future study.; The cardiac ultrasound will use standard ultrasound techniques to image two-dimensional slices of the heart using 3D real-time imaging.
Other intervention name(s): Spirometry; CT scan of the chest; Nasal wash; Nasal scrapping; Echo
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        The study population will be HIV positive subjects previously seen for other studies. There
        will be three centers enrolling, the University of Pittsburgh, the University of California
        San Francisco, and the University of California Los Angeles. Recruitment will occur from
        participants in ongoing lung studies at these sites.
      
Biospecimen description: 
      Whole blood, serum, bronchial wash and cells
    
Keywords: Antiretroviral therapy; pulmonary function; biomarkers