HIV Associated Chronic Obstructive Pulmonary Disease in Nigeria

Abstract

Objective To determine the prevalence and risk factors for chronic obstructive pulmonary disease (COPD) among HIV-infected adults in Nigeria. Design Cross-sectional study. Methods HIV-infected adults aged ≥ 30 years with no acute ailments accessing care at the antiretroviral therapy clinic of Jos University Teaching Hospital were enrolled consecutively. Participants were interviewed to obtain pertinent demographic and clinical information, including exposure to risk factors for COPD. Post-bronchodilator spirometry was carried out. HIV related information was retrieved from the clinic medical records. COPD case-definition was based on the Global Initiative for Obstructive Lung Disease (GOLD) criteria using post-bronchodilator FEV1/FVC <0.7. COPD prevalence was also calculated using the lower limit of normal for FEV1/FVC criteria (LLN) from the European Respiratory Society normative equation. Factors associated with COPD were determined using logistic regression models Results Study population comprised 356 HIV infected adults with mean age of 44.5 (standard deviation, 7.1) years and 59% were female. The mean time elapsed since HIV diagnosis was 7.0 (SD, 2.6) years and 97.5% of the respondents were on stable ART with virologic suppression present in 67.2%. Prevalence of COPD were 15.4% (95% confidence interval [CI] 11.7-19.2), 12.07% (95% CI 8.67-15.48), 22.19% (95% CI 18.16-26.83) using GOLD, ERS LLN and GLI LLN diagnostic criteria respectively. In multivariate analyses adjusting for gender, exposure to cigarette smoke or biomass, history of pulmonary tuberculosis, use of antiretroviral therapy, current CD4 T-cell count and HIV RNA, only age > 50 years was independently associated with COPD with OR 3.4; 95% CI 1.42-8.17 when compared to ages 30-40 years. Conclusion HIV-associated COPD is common in our population of HIV patients.

COPD in HIV-Infected Patients: CD4 Cell Count Highly Correlated

“…We did not find any correlation between ART exposure and COPD, nor between hepatitis and COPD, contrary to some previous studies using smaller populations [10,12,14,32]. Some previous studies also discussed an association between pneumocystis pneumonia or tuberculosis pneumonia with COPD [10, 19]. Our study did not find any association with these pathologies, but their low frequency in our population did not allow for any meaningful conclusions on this point (S1 Table).…”

“…04) [11]. Since the publication of this result, 5 high quality studies using spirometric criteria have found COPD rates between 6% and 21% in groups of 65 to 400 HIV outpatients representative of patients commonly treated in consultation units in the United-States, Spain, Italy and Nigeria [12,13,16,19,20]. Differences in prevalence were expected due to dissimilarities of methodology, age, smoking, histories and country-related respiratory exposure usually observed between the countries, but all of these studies confirmed similar high frequency of COPD.…”

Prevalence of chronic obstructive pulmonary disease in the global population with HIV: a systematic review and meta-analysis

“…Table 1 summarises the characteristics of included studies. 18 studies were from the Americas (Canada, Colombia, and the USA), [57][58][59][60][61][62][63][64][65][66][67][68][69]71,74,76,81,82 six were from Europe (Denmark, France, Italy, Spain, and UK), 70,72,75,76,79,80 four were from Africa (Cameroon, Nigeria, South Africa, and Uganda), 47,56,77,83 and one was from Japan. 77 One multiregional study included all WHO regions.…”

HIV Infection, Pulmonary Tuberculosis, and COPD in Rural Uganda: A Cross-Sectional Study

“…Their lower prevalence may be explained by a comparatively younger population with a lower smoking prevalence. Conversely, Nigerian investigators measured 15.4% prevalence of COPD among PLWH in urban Nigeria, although no association was found between COPD and tuberculosis[22]. Importantly, viral control was less common in the Nigerian cohort.…”