Relationship of Inflammation and Pulmonary Function to Fungal Translocation in HIV

Baseline, 18 month and 36 month visits will all be the same. URINE COLLECTION/INGESTION OF HYPOTONIC SOLUTION: Assessment of gut epithelial barrier integrity: Gut epithelial barrier integrity will be measured by the lactulose/mannitol differential sugar absorption test. The test will be performed at the CTRC the morning of the baseline visit. After an overnight fast, participants will be asked to ingest a solution of 5 grams of lactulose and 2 grams of mannitol in 100 mL of tap water. All urine passed in the subsequent five hours will be collected. Total urine volume will be measured and then a 100 mL volume will be stored at -80 degrees Celsius for later measurement of sugar absorption. BLOOD: The investigator will obtain approximately 90 ml (6 tablespoons) blood samples for measurement of BDG and proteins. Blood will be processed for serum, plasma, and PBMCs. Small amount will be used for hemoglobin and carboxyhemoglobin to accurately interpret PFT data. BREATHING TEST(PFT): Breathing tests are routine clinical tests that measure lung function; spirometry (measures the ability to move air in and out of the lungs), lung volumes (measures the amount of air trapped in the lungs), and DLco measure carbon monoxide. In addition, subjects will be asked to inhale two puffs of albuterol, which is an inhaled medicine (bronchodilator) that may open up breathing passages, and to repeat some of the breathing tests. The breathing test will be performed by a PFT technician, member of study team. ORAL WASH: Oral wash samples will be collected by a member of study team. To get the best specimen possible, the investigator needs to collect cells from the inside of the cheeks and gums. Participants will be asked to rinse 10ml of a saline solution vigorously from one side of their mouth to the other, concentrating on cheek-to-cheek swishing. SPUTUM: Sputum samples may be collected by a PFT technician. Participants will be asked to wash out their mouth before the testing. Participants will be administered albuterol before the sputum induction unless they just completed a PFT in which case they would have already received albuterol. and then breathe in and out mists of salt water (3% - 5% saline) with a mouthpiece for 20 minutes. During this time, participants will actively cough and spit out their saliva ("spit") and sputum into two separate cups every 4 minutes during 20 minutes. The investigator will also monitor participant's peak flow every 4 minutes (by blowing out as hard and fast as they can through a mouth piece) during the procedure. If peak flow falls to less than 80% of baseline, sputum induction will be discontinued and albuterol administered. The investigator will examine participant's sputum for the presence of bacteria and viruses, number of cells, and amounts of chemicals called mediators. These samples will also be used to measure any chemical compounds, cells or genes in the participant's body that are involved in emphysema, COPD or other organ involvement associated with COPD. STOOL: Participants may be provided with a stool collection kit at the study visit. Instructions on collection and return of the samples will be provided to the participants. QUESTIONNAIRES: Questionnaires related to demographics, tobacco and other substance use, medical history, medications, exacerbations, symptoms, and quality of life. will be administered by a member of research team to all participants. These are paper and pencil questionnaires and can be completed while waiting for other testing. MEDICAL RECORD REVIEW: Information regarding smoking, illicit drug and other medication usage will be obtained. Information regarding pulmonary and cardiac diagnosis and procedures will be obtained. Only information pertaining to this research and potential pulmonary outcomes will be researched.