A COPD Case-Finding Program in a Large Cohort of HIV-Infected Persons

Abstract

BACKGROUND: COPD screening guidelines in patients with HIV are lacking, and data about its under-diagnosis are still limited. This study aimed to determinate the feasibility of a case-finding program and the prevalence of COPD under-diagnosis in a large cohort of HIV-infected subjects. METHODS: All out-patients attending their routine visit for HIV monitoring at Spedali Civili General Hospital in Brescia, Italy, from February 2015 to January 2016, were enrolled. The case-finding program was structured in three steps: questionnaire administration, pre-bronchodilator spirometry testing measured with a portable spirometer, and post-bronchodilator diagnostic spirometry during a pulmonology appointment. RESULTS: A total of 1,463 subjects were included; the average age was 46.2 ؎ 10.3 y. Two hundred eighty-two subjects had a positive questionnaire; 190 completed portable spirometry, and approximately 34% (65 of 190 subjects) reported respiratory impairment; of these 65 subjects, 33 completed diagnostic spirometry, and 66.7% (22 of 33) showed evidence of COPD, including 2 subjects with severe airway obstruction (GOLD stage 3, according to the Global Initiative for Chronic Obstructive Lung Disease). High dropout rates were observed in our program. Individuals with COPD exacerbations showed lower CD4؉ cell counts at screening compared to those without acute worsening of symptoms (534 cells/mm 3 for subjects with GOLD 1 exacerbations and 495 cells/mm 3 for subjects with GOLD 2 exacerbations vs 781 cells/mm 3 for those without acute worsening of symptoms). The positive predictive value of the COPD screening questionnaire and portable spirometry was 33.8%. CONCLUSIONS: COPD may be underdiagnosed in HIV-infected people, and case-finding programs are an urgent issue to address as part of routine practice in these individuals.

Symptomatology and Quality of Life of Older People With HIV and Comorbid Chronic Obstructive Pulmonary Diseases From an HIV Clinic in Birmingham, Alabama

“…The previous study regarding the health outcome of PWH with COPD focused mainly on QoL and did not target older adults (Drummond et al, 2010; Kayongo et al, 2020). In addition, most recent studies regarding this population focus on the pathology, prevalence, and screening of COPD in PWH (Bigna et al, 2018; Depp et al, 2016; Gingo et al, 2018; Quiros-Roldan et al, 2019). Second, this study was conducted in the Deep South, where the prevalence of HIV and COPD is higher than the average in the United States (AIDSVu, 2019; Sullivan et al, 2018).…”

COPD in People with HIV: Epidemiology, Pathogenesis, Management, and Prevention Strategies

“…COPD remains both underdiagnosed and misdiagnosed in people with HIV. 150 , 151 While currently the US Preventative Services Task Force does not recommend screening for COPD in the general population, 152 higher COPD prevalence among PWH raises the question whether screening should be done in this subpopulation. Currently, there are no screening and diagnostic criteria specific to PWH.…”

“…While several studies have evaluated different screening approaches, no conclusive recommendations can be made regarding COPD screening and diagnosis in PWH at this time. 150 , 153–156 For example, a group in Canada offered screening spirometry to all patients in an HIV clinic; 156 notably, less than a third of the invited participants agreed to participate, and only 11% had airflow obstruction.…”

HIV and chronic lung disease

“…The propensity of PLWH toward COPD was first noted in 1992 when Diaz and colleagues reported 4 PLWH who had emphysema-like bullous changes, air trapping, hyperinflation, and reduced diffusion capacity, but no previous history of pulmonary infections [40]. Since then, in the cART era, the estimated prevalence of COPD has ranged between as low as less than 5% to upwards of 60% of cohorts, with definitions as varied as self-report [41,42], spirometry-confirmed [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59], computed tomography (CT) presence of emphysema [60][61][62][63][64][65][66][67], International Classification of Diseases (ICD) diagnostic codes [68][69][70][71][72][73][74][75][76][77], or chart review [78,79]. A 2018 meta-analysis reported pooled prevalence values of 10.5-10.6% by spirometry, 5.6% by ICD diagnostic codes, and 8.7% by patient selfreport [80].…”