Adiposity and Airway Inflammation in HIV-Associated Airway Disease

Adiposity and Airway Inflammation in HIV-Associated Airway Disease

The goals of this study are to 1) examine the relationships among inflammation, obesity, and asthma in people with HIV and 2) to test if special subtypes of cells or markers are present in the blood and lungs of people with HIV with asthma compared to those without asthma.

The proposed study involves the recruitment of participant population and the use of data from the existing research study cohorts that have been recruited and have provided informed consent for participation. Participants meet all inclusion/exclusion criteria will be enrolled into the study. Participants in the existing research study cohorts have pulmonary function testing, chest CT scans, and blood draws at each study visit which occurs every 18 months for 3 visits. Some of the study procedures may not be repeated if they were done as part of other research projects.

1. Main study visit

   The following research procedures may be performed over the course of one or more visits to accommodate scheduling needs. The study visit will take place at the Montefiore Clinical and Translational Research Center and the University of Pittsburgh Asthma Institute in the University of Pittsburgh Medical Center - Montefiore Hospital and may take up to 4 hours to complete.

   • Informed consent
   • Medical history review and demographics
   • Review of inclusion/exclusion criteria
   • Physical examination to include vital signs, weight and height, waist, hip, and thigh circumferences.
   • Urine pregnancy test for female of childbearing potential
   • Asthma-focused and quality of life questionnaire
   • Exhaled Nitric Oxide (eNO) measurement
   • Spirometry
   • Methacholine challenge testing - will not need to be repeated if the participant had done this as part of another study in the past 6 months.
   • Chest/Abdominal CT scans (If the participant has had the Chest CT scan done within 6 months as part of other research study, they will not be repeated for study purposes. Only the Abdominal CT will be performed)
   • Research blood sampling for biomarker analyses - some of this blood will also be used for pre-bronchoscopy testing in the case that the participant qualifies and is interested in undergoing part 2, the bronchoscopy visit.
   • Adipose tissue biopsy (Fat Biopsy): performed on participants with a BMI≥25). This will be repeated if done previously because testing to be done on the fat will be different than what had been tested on the fat previously.

2. Optional sub-study

On a separate visit, only a subset of 60 selected participants will be asked to undergo the following procedures to obtain additional lung biological samples. This visit is optional for participants who are willing to participate in the bronchoscopy portion. The investigators will try to recruit an equal number (n=15 per group) of obese asthmatics, obese non-asthmatics, non-obese asthmatics, and non-obese non-asthmatics. The visit will take place in the Montefiore Clinical Translational Research Center (MUH-CTRC). The bronchoscopy procedure will take about 30-45 minutes, but the preparation and recovery time will usually make the visit about 4-8 hours total.

Participants will be expected to fast for 8 hours prior to the bronchoscopy procedure and refrain from drinking any liquids the day of the procedure. Participants may take their usual medicines with sips of water.

• Clinical laboratory testing to include complete blood count/differential/platelet count, prothrombin time/partial thromboplastin time, international Normalized Ratio, blood urea nitrogen, and creatinine prior to bronchoscopy. If the patient refuses the first blood draw, the sample is inadequate, or the labs were run more than 30 days prior to the bronchoscopy visit, a second blood sample of up to 1 tablespoon may be drawn prior to the bronchoscopy procedure to ensure the patient is healthy enough for the procedure.

If Methacholine challenge was done more than 30 days prior to the visit two date, pulmonary function tests will be repeated.

• Oral Wash: participants will be asked to gargle with salt water for 1 minute and then spit into a container to provide a sample of approximately 10mls (2 teaspoons) at this study visit.
• Tongue Scraping: tongue blade or similar object will be used to scrape the participant's tongue. This sample will be used to determine what bacteria are on the participant's tongue. This procedure should only take minutes and is not painful.
• Participants will then rinse with 10cc's of Listerine. This is to assure that there are no bacteria left behind in the participant's mouth prior to the bronchoscopy.
• Bronchoscopy with bronchoalveolar lavage (BAL), endobronchial brushing and biopsy

Under local anesthesia, participants will undergo bronchoscopy with BAL for microbiologic specimens. A light intravenous anesthetic will be titrated to provide participant comfort if necessary. Vitals signs will be monitored continuously before, during, and after the procedure. This procedure consists of 3 stages.

1. Pulmonary Lavage: During pulmonary lavage, five 50 mL washes of sterile salt-water solution will be injected through the bronchoscope. Fluid will be collected with gentle suctioning for research studies.
2. Bronchial Brushing: A small brush will be introduced through the bronchoscope and gently rubbed over a very small part of the surface of the lungs. Approximately 10 brushes will be performed to collect epithelial cells.
3. Endobronchial Biopsy: While the bronchoscope is inserted, another small instrument will be passed through the bronchoscope to take small samples (biopsies) of tissue from the walls of the airways. Up to 5 samples may be taken during this procedure.

Following the bronchoscopy procedure, participants will be closely monitored in the bronchoscopy recovery area or return to the CTRC. Rarely, the participant's asthma may worsen during or after the procedure. Appropriate medical treatments or overnight observation will be provided if needed. Participants will not be allowed to drive home after the bronchoscopy. This is because the sedatives used during the procedure may decrease driving ability. The investigators will ask for the contact name and number of the person that will pick up the participant after the bronchoscopy

Inclusion Criteria:

1. 18 years of age or older
2. Subject who have been previously determined to be HIV positive through testing

Exclusion Criteria:

1. Pregnancy or breast-feeding
2. Contraindication to pulmonary function testing (i.e. abdominal or cataract surgery within 3 months, recent myocardial infarction, etc.)
3. Heart condition such as tachycardia, angina or arrhythmias
4. Acute respiratory infection: increasing respiratory symptoms or fever (temperature >100.4°F [38°C]) within 4 weeks of study entry
5. Hospitalization within 4 weeks of study entry
6. Uncontrolled hypertension at screening visit (systolic > 160 mm Hg or diastolic > 100 mm Hg) from an average of two or more readings (participant may return for screening after blood pressure is controlled)
7. Active cancer requiring systemic chemotherapy or radiation
8. Active infection of lungs, brain, or abdomen; or intravenous drug use or alcohol use that will impair ability to complete study investigations in the opinion of the investigator
9. History of prior lung resection