Chronic obstructive pulmonary disease in adults with human immunodeficiency virus infection: a systematic review

Elpis Giantsou,Duncan Powrie

doi:10.4236/health.2011.34039

Abstract

Objective: To determine the prevalence of chro- nic obstructive pulmonary disease (COPD) in adults with Human Immunodeficiency virus infection (HIV). Design: Systematic review of Medline, Embase, CINAHL, PsycINFO and references from identified papers. Study selection: Studies determining the prevalence of COPD in adults with HIV infection. Independent duplicate data extraction. Study quality was assessed in terms of whether consecutive patients were en- rolled, recruitment and follow-up periods were defined, 60% males, 60% on antiretroviral therapy. COPD was diagnosed by post-bronchodilator FEV1/FVC < 0.7 in three studies, by International Classification of Diseases (ICD-9) codes in three studies, by FEV1/FVC < 5% of lower adjusted normal in one and by pre- bronchodilator FEV1/FVC < 0.7 in another study. The prevalence was 10% - 35%, except for one study that recorded prevalence of 4% by postbronchodilator FEV1/FVC < 0.7, but <38% of patients with prebronchodilator FEV1/FVC < 0.7 had post-bronchodilator spirometry in that study. Conclusion: COPD is becoming increasingly common in HIV infected as they smoke and live longer due to efficient antiretrovirals. However, definite conclusions cannot be drawn and more longitudinal studies are needed. In the meantime health care providers should be vigilant to screen for undiagnosed COPD and hesitant to attribute respiratory symptoms solely to HIV infection.

Highlights

Effective antiretroviral therapies have improved the prognosis for patients infected with the Human Immunodeficiency Virus (HIV) [1]
HIV positive subjects have reported rates of respiratory symptoms comparable to those observed in elderly smokers, they are diagnosed with Chronic Obstructive Pulmonary disease (COPD) at younger age and smoke more than the general population
No definite conclusion about the prevalence of COPD in HIV can be drawn from the data available, as the reported prevalence varies considerably, it is evident that as HIV patients become an aging population, health care providers should consider COPD when evaluating HIV infected patients, especially those who present with respiratory symptoms or impairment

Summary

Introduction

Effective antiretroviral therapies have improved the prognosis for patients infected with the Human Immunodeficiency Virus (HIV) [1]. In the era of Highly Active Antiretroviral Therapy (HAART) patients with HIV infection live longer and experience increased mortality from causes not directly attributable to HIV. Recent data suggest that Chronic Obstructive Pulmonary disease (COPD) is becoming increasingly common in HIV-infected patients on antiretrovirals [3]. Even studies conducted before the introduction of HAART suggested that HIV infected patients have increased susceptibility to COPD. Diaz et al reported that the prevalence of emphysema in 114 HIV infected patients was 15% compared to only 2% in 44 HIV negative patients [4]. Poirier et al reported that the prevalence of airway hyperresponsiveness was 30.1% in 151 HIV positive smokers compared to 13.3% in 82 HIV negative smokers [5]. Morris et al Openly accessible at http://www.scirp.org/journal/HEALTH/

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