HIV-associated obstructive lung diseases: insights and implications for the clinician

Abstract

The effectiveness of antiretroviral therapy to control HIV infection has led to the emergence of an older HIV population who are at risk of chronic diseases. Through a comprehensive search of major databases, this Review summarises information about the associations between chronic obstructive pulmonary disease (COPD), asthma, and HIV infection. Asthma and COPD are more prevalent in HIV-infected populations; 16–20% of individuals with HIV infection have asthma or COPD, and poorly controlled HIV infection worsens spirometric and diffusing capacity measurements, and accelerates lung function decline by about 55–75 mL/year. Up to 21% of HIV-infected individuals have obstructive ventilatory defects and reduced diffusing capacity is seen in more than 50% of HIV-infected populations. Specific pharmacotherapy considerations are needed to care for HIV-infected populations with asthma or COPD–protease inhibitor regimens to treat HIV (such as ritonavir) can result in systemic accumulation of inhaled corticosteroids and might increase pneumonia risk, exacerbating the toxicity of this therapy. Therefore, it is essential for clinicians to have a heightened awareness of the increased risk and manifestations of obstructive lung diseases in HIV-infected patients and specific therapeutic considerations to care for this population. Screening spirometry and tests of diffusing capacity might be beneficial in HIV-infected people with a history of smoking or respiratory symptoms.

Airway bacteria and respiratory symptoms are common in ambulatory HIV-positive UK adults

“…These drugs, with a "class effect" (amphetamine-like) or not (dasatinib), are prescribed for serious (dasatinib, interferons) or moderate (benfluorex) pathologies and do not induce PAH in all patients [1][2][3][4][5][6][7][8][9]. As a result, assessment of drug history exposure from PAH patients has become essential for providing optimal disease management [10].…”

“…Studies in the USA have found that 16-20% of HIV-positive individuals have asthma or chronic obstructive pulmonary disease (COPD), and poorly controlled HIV accelerates lung function decline [1]. In HIV-negative patients with COPD, one report identified lower airway bacterial colonisation (LABC) in 44% of stable-state COPD patients, and found it to be associated with increasing airway inflammation, frequency of exacerbations and lung function decline [7].…”

Activation-induced Cell Death Drives Profound Lung CD4+T-Cell Depletion in HIV-associated Chronic Obstructive Pulmonary Disease

“…In this regard, select HIV-infected individuals who smoke cigarettes develop accelerated chronic obstructive pulmonary disease (COPD) through mechanisms that are incompletely understood (1)(2)(3)(4). However, the roles of HIV and host immunity in HIV-associated COPD remain poorly understood.…”

Pneumonia in HIV-Infected Patients

“…PI treatments (for example, ritonavir) can result in systemic accumulation of inhaled corticosteroids and may increase the risk of pneumonia by exacerbating the toxicity of this treatment in HIV-infected inhabitants with asthma or chronic obstructive pulmonary disease (25).…”