pulmonary disease

A recent review study investigated the prevalence of chronic obstructive pulmonary disease in those living with HIV.

Chronic obstructive pulmonary disease (DPOC) is a condition where the lungs do not work as well as they did and patients gradually have more difficulty breathing. It is characterized by persistent respiratory symptoms and airflow limitation, usually caused by long-term exposure to lung irritants, especially tobacco. It is progressive and incurable, but treatable. Chronic obstructive pulmonary disease is actually a term that encompasses other lung disorders, such as emphysema, bronchitis, and bronchiolitis. The World Health Organization (WHO) estimated that 210 million individuals worldwide have COPD and total deaths are expected to increase more than 30% in the next ten years.

Recent studies have reported an increased prevalence of chronic obstructive pulmonary disease among HIV positive patients. It is clear that the widespread use of highly active antiretroviral therapy is improving the survival of patients with HIV. Since HIV patients are living longer, healthcare practitioners are seeing an emergence of other concurrent conditions, such as COPD. HIV infection affects nearly 37 million people in the world, and although the high burden of chronic obstructive pulmonary disease and HIV is well known, the relationship between these two conditions is still unclear.

A review study conducted by Cameroonian researchers, published in the journal The Lancet in 2018, summarized data on the prevalence of chronic obstructive pulmonary disease in the global population with HIV and data on the association between exposure to HIV infection and COPD. The authors analyzed thousands of observational studies published up to 2017 and ended up selecting 30 studies containing relevant data on chronic obstructive pulmonary disease and HIV infection. Among the information collected were country of recruitment, mean or median age, HIV-related data (time since diagnosis, the proportion on antiretroviral treatment, viral load), the profile of tobacco smoking, and diagnostic criteria for chronic obstructive pulmonary disease.

Chronic Obstructive Pulmonary Disease in HIV Patients

Of the thirty studies retrieved, eighteen were from the Americas, six from Europe, four from Africa, one from Japan and one included global data. All thirty studies were included in the meta-analysis for chronic obstructive pulmonary disease prevalence, and the results showed that globally, the overall prevalence of COPD in the HIV infected population was 10.5%. However, the highest prevalence was found in Europe and increased according to income level, which means that the wealthier the region, the higher the prevalence of chronic obstructive pulmonary disease in HIV participants.

Viral Load is Associated with COPD

The researchers also found that the chronic obstructive pulmonary disease prevalence increased with proportion of smokers, which was already expected, as tobacco is a major cause of COPD. Another main finding is the correlation between detectable viral load (amount of HIV virus in the bloodstream) and chronic obstructive pulmonary disease. It means that patients with higher viral loads are more likely to develop chronic obstructive pulmonary disease than those with undetectable viral loads. On the other side, no correlation was seen between COPD and CD4 cell count (the number of CD4 T lymphocytes in the blood), suggesting that CD4 cell counts are not related to development or progression of chronic obstructive pulmonary disease. Eleven studies were included in the meta-analysis for the measurement of the association between HIV infection and chronic obstructive pulmonary disease. The results showed that the prevalence of chronic obstructive pulmonary disease was significantly higher among HIV patients than in HIV-negative people.

As suggested in other studies, exposure to HIV infection is a predisposing factor in chronic obstructive pulmonary disease, and this association was verified in this recent review study. The authors highlight the importance of these data for the global management of the HIV burden. Among the 37 million people living with HIV worldwide, close to four million have chronic obstructive pulmonary disease and these numbers are expected to increase since HIV positive patients are expected to live longer.

They recommend that policymakers should strengthen health systems for the management of this condition in this population. In this way, highly active antiretroviral therapy should be effectively implemented due to its ability to reduce the viral load and thus decrease the development of chronic obstructive pulmonary disease in this immunocompromised population.

Written by Gustavo Caetano, B.Sc., M.Sc.

Reference: Bigna J J, Kenne A M, Asangbeh S L, Sibetcheu A T. Prevalence of chronic obstructive pulmonary disease in the global population with HIV: a systematic review and meta-analysis. The Lancet 2018; v 6: 193 – 202.

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