Expanding access to antiretroviral therapy (ART) in resource-limited settings has resulted in prolonged survival for many HIV-infected (HIV+) individuals. As a consequence, chronic illness and aging-related disability are likely to increase as they have in cohorts of HIV+ individuals in developed countries. How this will impact lung health and the prevalence of chronic lung disease (CLD) among HIV+ individuals in resource-limited settings remains largely unknown. In developed countries, the incidence of infectious pulmonary complications of HIV has declined dramatically and CLD has surfaced as an increasingly important determinant of morbidity and mortality among HIV+ adults in the current ART era. In resource-limited countries where still proportionately fewer HIV+ individuals have access to ART, the extent to which a similar shift in pulmonary disease has occurred over the last 20 years has not been fully explored. Factors known to increase risk of CLD such as smoking tobacco may be less important in the developing world, and risk factors including vertically-acquired HIV, indoor biofuel burning and initiation of ART at lower CD4 cell counts may play more prominent roles. This project will evaluate risk factors for decreased lung function, measured using spirometry, to detect CLD among HIV+ individuals 10 years old who receive HIV-related medical care at the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya. The Hope Center was created in partnership with the University of Washington in 2004. Leveraging this established infrastructure and existing clinical research database, containing details of HIV disease stage and treatment, the applicant will collect standardized questionnaires and respiratory evaluations, including spirometry and pulse oximetry to achieve this project's specific aims, which are: 1) to determine risk factors for abnormal spirometry among HIV+ individuals and 2) to determine sensitivity, specificity and predictive value of a standardized assessment of self-reported respiratory symptoms, along with respiratory rate and oxygen saturation to identify HIV+ individuals with abnormal spirometry. To complete this project, the applicant will obtain formal training in advanced epidemiologic and biostatistical methods related to study design, data collection and analysis, and the responsible conduct of clinical research in resource-limited settings. This training and completion of this project will propel the applicant toward her goal of improving lung health in local and global settings as an independent clinical investigator, with a focus on HIV-related lung disease. This study will yield significant results that will enhance current knowledge of CLD risk factors among HIV+ individuals and identify modifiable risk factors that may be targeted in future studies to decrease the burden of CLD and its associated morbidity and mortality. In addition, clinical features of individuals at risk for abnormal spirometry will be identified and can be used to target future screening and improve treatment of these individuals in resource-limited settings.