Factors associated with abnormal spirometry among HIV-infected individuals

Drummond, M. Bradley; Huang, Laurence; Diaz, Philip T.; Kirk, Gregory D.; Kleerup, Eric C.; Morris, Alison; Rom, William N.; Weiden, Michael D.; Zhao, Enxu; Thompson, Bruce; Crothers, Kristina

doi:10.1097/qad.0000000000000750

Cited by 46 publications

(49 citation statements)

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“…Therefore, our findings identifying the critical step-offs in the COPD screening process represent the utility of our tool and cannot be applied to other existing tools. Notably, in an observational cohort of HIV-infected participants, 15% of those with respiratory symptoms had obstructed spirometry (21) as compared to our finding that 21% of those with symptoms as identified through our COPD screener tool had obstructed spirometry. This suggests that in an HIV-infected population, respiratory symptoms may not represent the best screening criteria for COPD.…”

Section: Discussioncontrasting

confidence: 55%

Implementation of a COPD Screening Questionnaire in an Outpatient HIV Clinic

Lambert

Drummond

Kisalu

et al. 2016

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Human immunodeficiency virus (HIV) is associated with increased risk for chronic obstructive pulmonary disease (COPD); yet substantial under-recognition of COPD exists. We administered a patient-completed, physician-reviewed COPD screening tool in an outpatient HIV clinic to determine whether screening is feasible or possible. Patients attending nonacute, routine HIV care visits were provided a brief COPD screening tool, which included three questions focused on age, respiratory symptoms, and smoking history. Providers were given completed forms for review and ordered spirometry at their discretion. Forms and medical records were subsequently reviewed to determine completion and results of spirometry testing. Of the 1,510 patients screened during the study period, 968 (64%) forms were completed. After excluding 79 incomplete forms, 889 (92%) unique patient forms were included in this analysis. Among these, 204 (23%) met criteria for spirometry referral, among whom physicians ordered spirometry in 64 (31%). At 6 months following study completion, 19 (30%) of the patients referred for spirometry had the test completed, with 5 (26%) demonstrating airflow obstruction. Nearly one out of four HIV patients met indication for screening spirometry and roughly one out of four undergoing spirometry had COPD. Critical drop-offs in the screening and diagnostic process occurred at questionnaire completion and spirometry ordering. Interventions tailored to these critical steps could improve the yield from COPD screening and help to optimize the identification of COPD in high-risk HIV-infected populations. COPD screening in a clinic focused on longitudinal HIV care can effectively identify COPD among those completing the screening continuum.

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Section: Discussioncontrasting

confidence: 55%

Implementation of a COPD Screening Questionnaire in an Outpatient HIV Clinic

Lambert

Drummond

Kisalu

et al. 2016

COPD: Journal of Chronic Obstructive Pulmonary Disease

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“…Using the SGRQ respiratory health questionnaire (which assesses not only respiratory symptoms but also the impacts on activity and quality of life), we found a 6-point difference in the median total score between HIV-positive and HIV-negative groups (a minimum clinically important difference in SGRQ being around 4 points [20]), suggesting that there is a meaningful impairment of the respiratory health of PLWH. This difference was present despite the prevalence of airflow obstruction in our HIV-positive subjects (11%) being lower than that reported in other HIV-positive populations (for instance 23% in Italy and 27% in the USA [8,21]). Of note, there was also no difference in the prevalence of airflow obstruction in our study between the HIV-positive and HIV-negative groups.…”

Section: Discussioncontrasting

confidence: 46%

Respiratory health status is impaired in UK HIV‐positive adults with virologically suppressed HIV infection

et al. 2017

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We sought to evaluate whether people living with HIV (PLWH) using effective antiretroviral therapy (ART) have worse respiratory health status than similar HIV-negative individuals. MethodsWe recruited 197 HIV-positive and 93 HIV-negative adults from HIV and sexual health clinics. They completed a questionnaire regarding risk factors for respiratory illness. Respiratory health status was assessed using the St George's Respiratory Questionnaire (SGRQ) and the Medical Research Council (MRC) breathlessness scale. Subjects underwent spirometry without bronchodilation. ResultsPLWH had worse respiratory health status: the median SGRQ Total score was 12 [interquartile range (IQR) 6-25] in HIV-positive subjects vs. 6 (IQR 2-14) in HIV-negative subjects (P < 0.001); breathlessness was common in the HIV-positive group, where 47% compared with 24% had an MRC breathlessness score ≥ 2 (P = 0.001). Eighteen (11%) HIV-positive and seven (9%) HIVnegative participants had airflow obstruction. In multivariable analyses (adjusted for age, gender, smoking, body mass index and depression), HIV infection remained associated with higher SGRQ and MRC scores, with an adjusted fold-change in SGRQ Total score of 1.54 [95% confidence interval (CI) 1.14-2.09; P = 0.005] and adjusted odds ratio of having an MRC score of ≥ 2 of 2.45 (95% CI 1.15-5.20; P = 0.02). Similar findings were obtained when analyses were repeated including only HIV-positive participants with a viral load < 40 HIV-1 RNA copies/mL. ConclusionsDespite effective ART, impaired respiratory health appears more common in HIV-positive adults, and has a significant impact on health-related quality of life.

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“…Several smaller studies have assessed pulmonary function in PLWHIV (online supplementary figure S1). The four largest spirometric studies include the Strategic Timing of Antiretroviral Treatment (START) pulmonary substudy (n=1026),28 the Lung-HIV consortium study (n=908),9 the France REcherche Nord & Sud Sida-HIV et He’patites (ANRS) EP48 HIV-CHEST cohort of smokers with prior immune deficiency (CD4 nadir count <350 cells/mm 3 ) above 40 years of age (n=351)19 and the AIDS Linked to the IntraVenous Experience (ALIVE) study of injection drug users (n=303 PLWHIV) 29. The latter two studies also included uninfected controls and were able to evaluate the effect of HIV.…”

Section: Discussionmentioning

confidence: 99%