Abstract
PurposeThe aim of this study was to estimate trends of incidence of hospital admissions and in-hospital mortality (IHM) in HIV-infected patients with COPD in the combination antiretroviral therapy (cART) era in Spain (1997–2012).MethodsA retrospective study with data from nationwide population-based COPD diagnoses in the Spanish Minimum Basic Data Set (MBDS) was performed. We established groups according to their HIV and HCV infections: 1) HIV-uninfected patients; 2) HIV-infected patients (with or without HCV coinfection).Results1,580,207 patients discharge with a COPD diagnosis were included in the study, 8902 of them were HIV-infected patients (5000 HIV-monoinfected patients and 3902 HIV/HCV-coinfected patients). The HIV-infected patients had higher incidence rates of hospital admissions for COPD than the HIV-uninfected patients during the study period. The HIV-monoinfected patients had higher rates of hospitalizations for COPD than the HIV/HCV-coinfected patients in the early-period cART (1997–1999), but these rates decreased in the first group and increased in the second, being even similar in both groups in the late-period cART (2004–2011). On the other hand, the HIV-infected patients with COPD had higher IHM than the HIV-uninfected patients with COPD. The mortality rates were higher in the HIV-monoinfected patients with COPD than in the HIV/HCV-coinfected patients with COPD in the early-period cART; however, in the late-period cART, the mortality rates trends seems higher in the HIV/HCV group. The likelihood of death in HIV/HCV-coinfected patients with COPD was similar to than in HIV-monoinfected patients with COPD.ConclusionsIncidence of hospital admissions for COPD and IHM have decreased among HIV-monoinfected individuals but have increased steadily among HIV/HCV-coinfected individuals in the cART era.
Highlights
Incidence of hospital admissions for chronic obstructive pulmonary disease (COPD) and in-hospital mortality (IHM) have decreased among human immunodeficiency virus (HIV)-monoinfected individuals but have increased steadily among HIV/Hepatitis C virus (HCV)-coinfected individuals in the combination antiretroviral therapy (cART) era
The introduction of combination antiretroviral therapy has resulted in a decline in infectious complications and mortality in persons living with the human immunodeficiency virus (HIV)[1,2]
We reviewed the results from the hospital survey of HIV/AIDS infected patients, a second-generation surveillance system in people living with HIV coordinated by the National Centre of Epidemiology [30], and the reports of two Spanish national cohorts: the “Grupo de Estudio de Sida” (GeSIDA) [31] and the “Asociacion Medica VACH de Estudios Multicentricos (AMVACH)” [32]
Summary
The introduction of combination antiretroviral therapy (cART) has resulted in a decline in infectious complications and mortality in persons living with the human immunodeficiency virus (HIV)[1,2]. The pathogenic mechanisms of HIV-associated COPD remains unclear [5], it may be due in part to higher prevalence of smoking in these individuals [6]. Other risk behaviors, such as use of injected and inhalational drugs, damage the lungs [7]. Pulmonary infections such as bacterial pneumonia and pulmonary colonization by Pneumocystis jirovecii may contribute to the pathogenesis of COPD [8,9]. Potential explanations include direct effects of these drugs, restoration of the immune system allowing for an increased inflammatory response after therapy is initiated, or the development of autoimmunity [5]
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