Air pollution, lung function, and respiratory symptoms in the MACS and WIHS

<bold>Background:</bold> Ambient air pollution is associated with chronic lower respiratory disease. HIV is also a risk factor for COPD. We sought to characterize the associations of pollution exposures with lung function and respiratory symptoms in people with HIV (PWH) or at risk for HIV. We hypothesized that associations would differ by HIV status. <bold>Methods:</bold> We analyzed data from the Multicenter AIDS Cohort Study and Women’s Interagency HIV Study. One-year averages of daily fine particulate matter (PM_2.5) and 8-hour maximum ozone (O₃) were assigned based on residential census tract at time of PFT. Linear models, adjusted for age, race, ethnicity, current smoking, smoking pack-years, BMI, CD4 count, CD4/CD8 ratio, and HIV viral load were used to quantify associations between increases of 3 ppb O₃ or 1 µg/m³ PM_2.5 and respiratory outcomes (PFT, SGRQ, mMRC). We performed subgroup analysis in those with COPD. <bold>Results:</bold> Among 338 men (43% PWH, 8.6% with COPD) and 1073 women (72% PWH, 10% with COPD) there was no association between PM_2.5 or O₃ exposure and lung function. In the subgroup with COPD (n=140, 44 PWH), O₃ exposure was independently associated with lower FEV1/FVC only in PWH (−0.018, 95% CI -0.03 to -0.002). PM_2.5 exposure was associated with worse SGRQ (+4.04, 95% CI 0.36-7.72) and mMRC scores (+0.28, 95% CI 0.02-0.53) only in PWH. <bold>Conclusions:</bold> PWH with COPD had lower FEV1/FVC associated with increase in O₃ and worse respiratory symptoms with increase in PM_2.5 than those without HIV. HIV may be a susceptibility factor for air pollution health effects among individuals with lung disease. Further studies are needed to understand how this chronic viral infection predisposes PWH to COPD progression from air pollution.