Air pollution, HIV and mortality

<bold>Background:</bold> Air pollution is the leading environmental cause of death and tied to worse lung health. Persons with HIV(PWH) face increased risk of impaired lung function and COPD. In PWH the impact of air pollution on disease burden and mortality is unknown. We describe relationships between air pollution and mortality in a cohort of PWH and matched at-risk HIV-uninfected persons. <bold>Methods:</bold>We utilized longitudinal lung function (FEV₁), clinical, and ambient air pollution data (6-month average PM_2.5 and NO₂) from US EPA data by address in the ALIVE cohort 2009-2019. All-cause and cause-specific mortality were derived from the National Death Index. Cox-proportional hazard models analyzed associations between air pollution and mortality every 6-months overall and by HIV status, adjusting for FEV1, demographics, substance use, and comorbidities. <bold>Results:</bold>1640 participants(495 PWH) contributed 12,712 assessments. Median age was 51 and median PM_2.5 was 10_ug/m³ [IQR 9-11]. Both PM_2.5 and NO₂ were associated with mortality risk in the overall cohort (Fig 1). Among PWH a 2ug/m3 increase in PM_2.5 was associated with all-cause (HR 2.32,p<0.01) and HIV-or-infection-related (HR 2.23,p=0.01) mortality. Increased PM_2.5 and NO₂ was associated with higher chronic-disease related mortality. <bold>Conclusions:</bold>Air pollution was independently associated with increased mortality in this high-risk population, highlighting the importance of efforts to improve air quality in vulnerable populations, including PWH. <fig><object-id>erj;64/suppl_68/PA1308/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>