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Smoking and human immunodeficiency virus 1 (HIV-1) infection are risk factors for chronic obstructive pulmonary disease (COPD), which is among the most common comorbid conditions in people living with HIV-1. HIV-1 infection leads to persistent expansion of CD8 + T cells, and CD8 + T cell-mediated inflammation has been implicated in COPD pathogenesis. In this study, we investigated the effects of HIV-1 infection and smoking on T-cell dynamics in patients at risk of COPD. BAL fluid, endobronchial brushings, and blood from HIV-1 infected and uninfected nonsmokers and smokers were analyzed by flow cytometry, and lungs were imaged by computed tomography. Chemokines were measured in BAL fluid, and CD8 + T-cell chemotaxis in the presence of cigarette smoke extract was assessed in vitro . HIV-1 infection increased CD8 + T cells in the BAL fluid, but this increase was abrogated by smoking. Smokers had reduced BAL fluid concentrations of the T cell-recruiting chemokines CXCL10 and CCL5, and cigarette smoke extract inhibited CXCL10 and CCL5 production by macrophages and CD8 + T-cell transmigration in vitro . In contrast to the T cells in BAL fluid, CD8 + T cells in endobronchial brushings were increased in HIV-1-infected smokers, which was driven by an accumulation of effector memory T cells in the airway mucosa and an increase in tissue-resident memory T cells. Mucosal CD8 + T-cell numbers inversely correlated with lung aeration, suggesting an association with inflammation and remodeling. HIV-1 infection and smoking lead to retention of CD8 + T cells within the airway mucosa.

Background: Individuals with chronic obstructive pulmonary disease (COPD) often experience high health-care utilization following pulmonary rehabilitation, suggesting suboptimal transitions to home., Objective: To understand the experiences of persons with COPD and health-care professionals regarding transitions from pulmonary rehabilitation to home, including factors impacting these transitions., Design: A descriptive qualitative study., Setting and Participants: Health-care professionals working at, and persons with COPD who attended, an inpatient or outpatient pulmonary rehabilitation programme at one large, urban health-care centre. The centre is located in Ontario, Canada., Main Variable Studied: Experiences of participants with care transitions between pulmonary rehabilitation and home. Semi-structured interviews were audio-recorded, transcribed verbatim, and thematically analysed., Results: Ten patients and eight health-care professionals participated. Four main themes were identified around the overall experiences with pulmonary rehabilitation and transitions to home: (a) pulmonary rehabilitation as a safe environment; (b) pulmonary rehabilitation as a highly structured environment; (c) contrasting perceptions of the role of pulmonary rehabilitation; and (d) dependency on pulmonary rehabilitation programmes. Persons with COPD and health-care professionals identified three key factors that influenced this transition: (a) patients' social support, (b) application of self-management strategies prior to discharge, and (c) patients' physical and mental health., Conclusion: Participants agreed that some patients with COPD experienced suboptimal transitions from pulmonary rehabilitation to home that were characterized by suboptimal self-management. Further research is needed to develop and evaluate interventions to improve transitions. Such interventions should include strategies to elicit long-term behaviour change to assist patients when they return into the community., (© 2019 The Authors Health Expectations published by John Wiley & Sons Ltd.)