The convergence of the global smoking, COPD, tuberculosis, HIV, and respiratory infection epidemics

Abstract

At the beginning of the 21st century, we are facing the convergence of several epidemics. These include tobacco smoking, tuberculosis, HIV infection, influenza, and chronic obstructive pulmonary disease. These epidemics interact by way of increasing disease susceptibility and worsening outcomes. To control these interacting epidemics, we need to better understand each infection and how it influences the others. Multifaceted approaches will be necessary to reduce the impact on those in developing nations most likely to be affected by the convergence of all epidemics.

Figure 1

The central role of smoking in pulmonary infections, HIV and COPD, and the interactions of several of the individual diseases. The dashed lines indicate increased risk of disease associated with tobacco smoking. The solid line indicates increased risk associated with other diseases.

Figure 2

Overview of the systemic and local effects of tobacco smoke on the immune system and pulmonary defence mechanisms against infection.