Chronic obstructive pulmonary disease (COPD) occurs at twice the rate in individuals with HIV as those without. Better understanding of the inflammatory process behind this accelerated disease rate will assist in guiding future therapeutic trials in both HIV-related COPD and COPD in general. Our previous work demonstrated that using a single low radiation dose computed tomography (CT) scan we can identify individuals with different clinical expression of their lung disease. In this proposal we ill examine the inflammatory cell underpinnings of HIV-related COPD with an aim at guiding future therapeutic trials.
COPD in smokers with HIV is both accelerated and unusual in the preponderance of activated macrophages despite advances in treating the underlying adaptive immune deficiency state. In this proposal we propose a logical protocol to identify individuals with a high likelihood of demonstrating distinct macrophage activations states that should be amenable to existing therapeutics. We will utilize invasive sampling of lung immune cells and high speed cell sorting techniques to confirm inflammatory cell related hypotheses and simultaneously generate clinical information of implications of adopting cancer screening protocols in the heavily smoking burdened HIV population. The proposed studies will generate clinically relevant information that can help guide future therapeutic trials.