By Mary Henderson
With the advent of antiretroviral therapy (ART), individuals infected with HIV are now living for decades. This increased longevity means that while opportunistic lung infections have dropped precipitously, chronic obstructive pulmonary disease (COPD) and emphysema have emerged as major comorbidities in people living with controlled HIV.
Tuesday afternoon, Yanisa Jarusyingdumrong, MD, a radiologist in Bangkok working with the HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), presented results of a CT-based analysis on the prevalence of emphysema among older people living with HIV compared to individuals who are HIV-negative. <
“Previous studies have shown that people living with HIV had more emphysema than those without HIV,” Dr. Jarusyingdumrong said. “But according to recent research in the U.S. and Europe, there's not much difference compared to the general population, most likely because of the shift to combined ART.”
“There’s very limited data from Asia, so we wanted to explore whether that same pattern exists in the Thai population,” she added.“The prevalence of emphysema is similar in well-treated individuals with HIV and HIV-negative adults over 50. Longer duration on ART is linked with a lower prevalence of the disease, which suggests a possible protective effect of the therapy.”
Yanisa Jarusyingdumrong, MD
Dr. Jarusyingdumrong and colleagues conducted a retrospective, cross-sectional study, using CT scans performed in 2016 and 2017. The study included 479 participants: 335 people living with HIV (63% male, average age 54, average BMI 23.1) and 144 HIV-negative individuals (62% male, average age 58, average BMI 25.1).
Of the individuals living with HIV, just over 63% had never smoked; nearly 23% were previous smokers and almost 14% were current smokers. For those who were negative for HIV, smoking status was nearly 65%, 25% and 10%, respectively. The average pack-years was 10 for both groups, and total lung volume was also similar between the patient populations.
“These two groups have many similarities, but two differences stood out,” Dr. Jarusyingdumrong said. “As a group, the individuals living with HIV were younger, and they also had a slightly lower BMI than the non-HIV group.”
Nearly 98% of individuals living with HIV in the study were virally suppressed, and the median duration of ART was 18 years. Two radiologists independently performed a visual assessment of the chest CT images, which were also evaluated quantitatively by computer software.
According to results of the visual assessment, 12% of people in the study living with HIV had emphysema, compared to 10% prevalence among the HIV-negative subjects.
“The prevalence of emphysema is similar in well-treated individuals with HIV and HIV-negative adults over 50,” Dr. Jarusyingdumrong said. “Longer duration on ART is linked with a lower prevalence of the disease, which suggests a possible protective effect of the therapy.”
Based on the results of the study, Dr. Jarusyingdumrong said it’s important to ensure HIV-infected individuals are compliant with ART and to help prevent emphysema by focusing on traditional risk factors—especially smoking.
“The four factors associated with a higher risk for emphysema among the HIV-infected group were older age, lower BMI, current smoking and pulmonary tuberculosis infection,” she said.
There was a significant mismatch between the visual and quantitative CT assessments, with the latter detecting a much lower disease prevalence in both patient populations. Dr. Jarusyingdumrong said future studies should be larger to boost statistical power and consider environmental exposures. “Refining classification through more reference images, adjusting quantitative thresholds and considering hybrid and AI approaches could help address the weak correlation between visual and quantitative assessments,” she said.
Access the session, “Prevalence of Emphysema Among Older People Living with HIV Compared to HIV-Negative Individuals in the Combined Antiretroviral Therapy Era: A CT-Based Analysis,” (T6-SSCH06-6) on demand at RSNA.org/MeetingCentral
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The RSNA 2025 Daily Bulletin is the official publication of the 110th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Published online Sunday, November 30 — Thursday, December 4.
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