Interactions between HIV infection and chronic obstructive pulmonary disease: Clinical and epidemiological aspects

Abstract

Introduction: An association between HIV infection and chronic obstructive pulmonary disease (COPD) has been observed in several studies.

Objective and methods: we conducted a review of the literature linking HIV infection to COPD, focusing on clinical and epidemiological data published before and during widespread highly active antiretroviral therapy (HAART).

Results: Interactions between HIV infection and COPD appear to be influenced by multiple factors. In particular, the bronchopulmonary tract can be damaged by HIV infection, the immunodeficiency it induces, and the resulting increase in the risk of pulmonary infections. In addition, the prevalence of smoking and intravenous drug use is higher in HIV-infected populations, also increasing the risk of COPD. Before the advent of HAART, respiratory tract infections probably played a major role. Since the late 1990s and the widespread use of HAART, the frequency of opportunistic infections has fallen but new complications have emerged as life expectancy has increased.

Conclusion: given the high prevalence of smoking among HIV-infected patients, COPD may contribute significantly to morbidity and mortality in this setting.

Figure 1

Predictors of COPD (OR with 95%CI) for some of the risk factors identified (using ICD-9 codes) in multivariate analysis as independently associated with a diagnosis of chronic airflow obstruction, among 1014 HIV-positive and 713 HIV-negative US veterans [31].

Figure 2

Predictors of COPD (OR with 95%CI) for risk factors independently associated with airflow obstruction, diffusion impairment, both, and symptoms in a cohort of 167 HIV-infected subjects [34]. Age/10 y: age in ten-year periods. Smoking/10 pack-years: smoking per ten pack-years.

Figure 3

Factors underlying COPD-HIV interaction and their evolutions between pre-HAART era (blue circles) and HAART era (white circles).