To analyze the influencing factors of chronic obstructive pulmonary disease (COPD) in patients with acquired immunodeficiency syndrome (AIDS).

A total of 398 AIDS patients admitted to our hospital from January 2020 to December 2023 were enrolled and divided into groups based on the degree of diffusion impairment: normal diffusion function group 48 cases, mild decline group 40 cases, moderate decline group 92 cases, and severe decline group 218 cases. Clinical data were collected, and statistical methods including t-test, analysis of variance (ANOVA), χ² test, and Logistic regression were used to analyze the factors influencing COPD in AIDS patients.

Statistically significant differences (P<0.05) were observed among the groups in terms of body weight, CD4⁺ and CD8⁺ cell counts, smoking history, cough, expectoration, IL-6 levels, right ventricular measurements, bronchiectasis, Pneumocystis pneumonia(PCP), pulmonary tuberculosis, and pulmonary fungal infections. Multivariate analysis revealed that body weight (OR=0.944, 95%CI: 0.909~0.979), smoking (OR=2.798, 95%CI: 1.452~5.392), and CD4⁺ cell count (OR=0.996, 95%CI: 0.994~0.998) were influencing factors for diffusion dysfunction in AIDS patients. Significant differences (P<0.05) were also found in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), maximal mid-expiratory flow (MMEF75/25), peak expiratory flow (PEF), total lung capacity (TLC), residual volume (RV), and maximal vital capacity (VC MAX) among the groups. At the end of the 3-year follow-up, 251 patients had not developed COPD, while 99 had, with the distribution as follows: 0 cases in normal group, 2 cases(5.00%) in mild group, 19 cases (20.65%) in moderate group, and 78 cases(35.78%) in severe group (P<0.001). Compared to non-COPD patients, AIDS patients with COPD exhibited statistically significant differences (P<0.05) in body weight, smoking, hospitalization frequency, CD4⁺ and CD8⁺ lymphocyte counts, concurrent PCP, pulmonary tuberculosis, pulmonary fungal infections, Talaromyces marneffei infection, FEV₁, FVC, and FEV₁/FVC ratio. Severe and persistent diffusion impairment was identified as a risk factor for COPD in AIDS patients (OR=2.699, 95%CI: 1.571~4.637).

Smoking is a risk factor for diffusion dysfunction in AIDS patients, while body weight and CD4⁺ cell count are predictive factors. Smoking, severe diffusion impairment, and hospitalization history are risk factors for COPD in AIDS patients, whereas CD4⁺ cell count and body weight serve as predictive factors. Maintaining normal CD4⁺ cell levels, adhering to standardized antiviral therapy, smoking cessation, improving nutrition, and controlling pulmonary infections may help enhance diffusion function and reduce COPD incidence in this population.