Background <p>Chronic respiratory disease is a significant contributor to morbidity among persons living with HIV (PLWH). In the general population, indoor air pollution is associated with respiratory morbidity. There is limited data on the respiratory health effects of indoor air pollution among PLWH, and the potential role of air pollution exposure in driving respiratory comorbidities in HIV.</p> Methods <p>Participant data from the Study of HIV in the Etiology of Lung Disease (SHIELD), a cohort of participants with or at risk for HIV in Baltimore, MD, was utilized. The association between reported household exposures and chronic respiratory symptoms was analyzed from baseline questionnaire data. A complementary pilot study directly measured weeklong average household fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) concentrations in participant homes. Logistic regression models described associations between household pollutants and patient-reported measures of respiratory morbidity for participants with and without HIV after accounting for confounders including smoking and spirometry measures.</p> Results <p>A total of 1997 (<i>n</i> = 1109 PLWH) SHIELD participants were included. Most participants were black (83%, <i>n</i> = 1665) and male (65%, <i>n</i> = 1298) with low socioeconomic status. There was a high prevalence of current tobacco use (78%, <i>n</i> = 1553). Most PLWH (69%, <i>n</i> = 767) had HIV RNA &lt; 400 copies/mL. 21% (<i>n</i> = 412) of participants had spirometry-confirmed airflow obstruction. Self-reported household environmental exposures were associated with chronic respiratory symptoms, and PLWH appeared more susceptible to certain sources of pollution. HIV notably modified the effect of reported household secondhand smoke and NO₂ producing appliances on respiratory symptoms including chronic wheeze. The SHIELD Home pilot (<i>N</i> = 36) revealed household PM_2.5 concentrations above WHO recommend limits, with elevated household PM_2.5 associated with cough, sputum production, and worse respiratory quality of life as measured by the COPD Assessment Test.</p> Conclusions <p>Household pollutant exposure was common in an urban cohort enriched for PLWH. Early evidence suggests that HIV may increase susceptibility to certain pollutants. The SHIELD Home pilot provides early evidence of the potential impact of household PM_2.5 on respiratory disease in HIV. Studies are needed to enhance our understanding of the contribution of indoor air pollution to lung disease among PLWH.</p>