Increased Risk of Radiographic Emphysema in HIV Is Associated With Elevated Soluble CD14 and Nadir CD4

Attia, Engi F.; Akgün, Kathleen M.; Wongtrakool, Cherry; Goetz, Matthew Bidwell; Rodriguez‐Barradas, Maria C.; Rimland, David; Brown, Sheldon T.; Hoo, Guy W. Soo; Kim, Joon; Lee, Patricia; Schnapp, Lynn M.; Sharafkhaneh, Amir; Justice, Amy C.; Crothers, Kristina

doi:10.1378/chest.14-0543

Cited by 97 publications

(130 citation statements)

References 55 publications

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“…In the first study, COPD was much more common in current smokers (OR 5.25, 95% CI 1.62-17.01) and ex-smokers (OR 5.25, 95% CI 1.53-17.99) than in never-smokers [12], while in the second, HIV infection was documented to be an independent risk factor for COPD [148]. Interestingly, a number of studies have indicated that HIV infection is associated with the emphysema phenotype of COPD, further strengthening the suggestion of an overall association between HIV infection and COPD [149,150].…”

Section: Obstructive Lung Disease (Copd and Asthma)mentioning

confidence: 85%

Impact of HIV infection and smoking on lung immunity and related disorders

2015

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HIV-infected persons not only have higher rates of smoking than the general population, but are also unusually vulnerable to the associated adverse health effects, both infective and noninfective in origin. Indeed, in the setting of well-organised care and availability of highly active antiretroviral therapy, HIV-infected smokers lose more life-years to smoking than to HIV infection per se, presenting a major challenge to healthcare providers. Not surprisingly, the respiratory system is particularly susceptible to the damaging interactive chronic inflammatory and immunosuppressive effects of HIV and smoking, intensifying the risk of the development of opportunistic infections, as well as lung cancer and obstructive lung disorders. The impact of smoking on the immunopathogenesis and frequencies of these respiratory conditions in the setting of HIV infection, as well as on the efficacy of antiretroviral therapy, represent the primary focus of this review. @ERSpublications Smoking exacerbates the immunosuppressive/pro-inflammatory effects of HIV, increasing the risk of pulmonary disease

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Section: Obstructive Lung Disease (Copd and Asthma)mentioning

confidence: 85%

Impact of HIV infection and smoking on lung immunity and related disorders

2015

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“…There is evidence from multiple sources of lung function impairment in people with long-standing HIV infection 4 5. Although most current evidence comes from cohorts in the USA or Europe and less is known about populations in other settings, higher rates of respiratory pathology despite antiretroviral treatment have been a consistent finding of studies in HIV-positive populations 6–8.…”

Section: Introductionmentioning

confidence: 99%

Respiratory symptoms in people living with HIV and the effect of antiretroviral therapy: a systematic review and meta-analysis

Brown

Roy

Harris

et al. 2016

Thorax

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BackgroundAntiretroviral therapy (ART) has significantly altered the pattern of acute and chronic HIV-related disease. However, it is not clear what this means in terms of respiratory symptoms. We sought to investigate the association between HIV status and respiratory symptoms and how these have changed with the availability of ART.MethodsWe searched Cochrane, Medline and Embase databases for studies published between 1946 and August 2015 comparing the prevalence of respiratory symptoms in populations with and without HIV infection. We undertook random effects meta-analysis of the main symptoms reported. We studied heterogeneity and completed sensitivity analyses and funnel plots.ResultsFrom 5788 unique references identified, 24 papers provided relevant data: 18 documented the prevalence of cough and 11 examined the prevalence of breathlessness among other symptoms reported. Compared with the HIV negative, people living with HIV (PLWH) were more likely to have respiratory symptoms with pooled ORs for the prevalence of cough of 3.05 (95% CI 2.24 to 4.16) in resource-limited populations without access to ART; 2.18 (1.56 to 3.18) in resource-rich populations without access to ART and 1.11 (0.99 to 1.24) in resource-rich populations with access to ART. In resource-rich settings, although the availability of ART was associated with a reduction in the difference between HIV-positive and HIV-negative individuals, PLWH were more likely to report breathlessness, OR 1.39 (95% CI 1.11 to 1.73).ConclusionsRespiratory symptoms are more common in PLWH than controls. This association persists although at a reduced level in populations with access to ART.

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“…Persistent HIV-associated immune dysregulation despite ART may also contributean effect documented in the development of atherosclerosis [25]. This hypothesis is supported by Attia et al's finding that levels of circulating CD14 are associated with radiographic emphysema in HIV-positive individuals [26]. Prospective studies are needed to determine the relative importance of these possible causes.…”

Section: Discussionmentioning

confidence: 90%

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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Increased Risk of Radiographic Emphysema in HIV Is Associated With Elevated Soluble CD14 and Nadir CD4

Cited by 97 publications

References 55 publications

Impact of HIV infection and smoking on lung immunity and related disorders

Impact of HIV infection and smoking on lung immunity and related disorders

Respiratory symptoms in people living with HIV and the effect of antiretroviral therapy: a systematic review and meta-analysis

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

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