Prevalence and determinants of chronic obstructive pulmonary disease in HIV infected patients in an African country with low level of tobacco smoking

Pefura-Yone, E.W.; Fodjeu, Gaspary; Kengne, André Pascal; Roche, N.; Kuaban, Christopher

doi:10.1016/j.rmed.2014.12.003

Cited by 39 publications

(45 citation statements)

References 23 publications

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“…Cameroon investigators measured lower COPD prevalence among PLWH (2.2%) but describe similar associations between HIV, tuberculosis and COPD[21]. Their lower prevalence may be explained by a comparatively younger population with a lower smoking prevalence.…”

Section: Discussionmentioning

confidence: 94%

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

North

Allen

Okello

et al. 2017

Lung

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Section: Discussionmentioning

confidence: 94%

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

North

Allen

Okello

et al. 2017

Lung

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“…The resultant immune dysregulation is associated with end-organ damage [58,62–64], and may be important mechanistically in CLD development. HIV itself is an independent risk factor for COPD among adults [6,65,66]. Preliminary data suggest that HIV is also independently associated with CLD in children and adolescents [12*,15*,18**].…”

Section: Risk Factors For Hiv-associated Chronic Lung Disease Among Amentioning

confidence: 99%

Bronchiectasis and other chronic lung diseases in adolescents living with HIV

Attia

Miller

Ferrand

2017

Current Opinion in Infectious Diseases

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Purpose of review The incidence of pulmonary infections has declined dramatically with improved access to antiretroviral therapy (ART) and co-trimoxazole prophylaxis, but chronic lung disease (CLD) is an increasingly recognized but poorly understood complication in adolescents with perinatally-acquired HIV. Recent findings There is a high prevalence of chronic respiratory symptoms, abnormal spirometry and chest radiographic abnormalities among HIV-infected adolescents in sub-Saharan Africa, where 90% of the world’s HIV-infected children live. The incidence of lymphocytic interstitial pneumonitis, the most common cause of CLD in the pre-ART era, has declined with increased ART access. Small airways disease, particularly constrictive obliterative bronchiolitis and bronchiectasis are emerging as leading causes of CLD among HIV-infected adolescents in low- and middle-income countries. Asthma may be more common in high-income settings. Likely risk factors for CLD include recurrent pulmonary infections, air pollution, HIV-related immune dysfunction and untreated HIV infection, particularly during critical stages of lung development. Summary Globally, the importance of HIV-associated CLD as a cause of morbidity and mortality is increasing, especially as survival has improved dramatically with ART and growing numbers of children living with HIV enter adolescence. Further research is urgently needed to elucidate the natural history and pathogenesis of CLD, and to determine optimal screening, diagnostic and treatment strategies.

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“…Findings from two observational studies suggested ART use was associated with an increased risk of COPD, 5,6 results from another study showed a lower incidence of COPD among ART users, 7 and results from other studies showed no association. 8–11 All these studies were limited by their observational designs, in which ART use might be confounded by factors such as socioeconomic status, adherence to medical therapy, and other health behaviours that might affect both the likelihood of ART use and COPD risk.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary effects of immediate versus deferred antiretroviral therapy in HIV-positive individuals: a nested substudy within the multicentre, international, randomised, controlled Strategic Timing of Antiretroviral Treatment (START) trial

Kunisaki

Niewoehner

Collins

et al. 2016

The Lancet Respiratory Medicine

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Summary Background Observational data have been conflicted regarding the potential role of HIV antiretroviral therapy (ART) as a causative factor for, or protective factor against, COPD. We therefore aimed to investigate the effect of immediate versus deferred ART on decline in lung function in HIV-positive individuals. Methods We did a nested substudy within the randomised, controlled Strategic Timing of Antiretroviral Treatment (START) trial at 80 sites in multiple settings in 20 high-income and low-to-middle-income countries. Participants were HIV-1 infected individuals aged at least 25 years, naive to ART, with CD4 T-cell counts of more than 500 per µL, not receiving treatment for asthma, and without recent respiratory infections (baseline COPD was not an exclusion criterion). Participants were randomly assigned to receive ART (an approved drug combination derived from US Department of Health and Human Services guidelines) either immediately, or deferred until CD4 T-cell counts decreased to 350 per µL or AIDS developed. The randomisation was determined by participation in the parent START study, and was not specific to the substudy. Because of the nature of our study, site investigators and participants were not masked to the treatment group assignment; however, the assessors who reviewed the outcomes were masked to the treatment group. The primary outcome was the annual rate of decline in lung function, expressed as the FEV1 slope in mL/year; spirometry was done annually during follow-up for up to 5 years. We analysed data on an intention-to-treat basis, and planned separate analyses in smokers and non-smokers because of the known effects of smoking on FEV1 decline. The substudy was registered at ClinicalTrials.gov number NCT01797367. Findings Between March 11, 2010, and Aug 23, 2013, we enrolled 1026 participants to our substudy, who were then randomly assigned to either immediate (n=518) or deferred (n=508) ART. Median baseline characteristics included age 36 years (IQR 30–44), CD4 T-cell count 648 per µL (583–767), and HIV plasma viral load 4·2 log10 copies per mL (3·5–4·7). 29% were female and 28% were current smokers. Median follow-up time was 2·0 years (IQR 1·9–3·0). We noted no differences in FEV1 slopes between the immediate and deferred ART groups either in smokers (difference of –3·3 mL/year, 95% CI –38·8 to 32·2; p=0·86) or in non-smokers (difference of –5·6 mL/year, –29·4 to 18·3; p=0·65) or in pooled analyses adjusted for smoking status at each study visit (difference of –5·2 mL/year, –25·1 to 14·6; p=0·61). Interpretation The timing of ART initiation has no major short-term effect on rate of lung function decline in HIV-positive individuals who are naive to ART, with CD4 T-cell counts of more than 500 per µL. In light of updated WHO recommendations that all HIV-positive individuals should be treated with ART, regardless of their CD4 T-cell count, our results suggest an absence of significant pulmonary harm with such an approach. Funding US National Heart Lung and Blood Institute, US N...

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Prevalence and determinants of chronic obstructive pulmonary disease in HIV infected patients in an African country with low level of tobacco smoking

Abstract: HIV infection is possibly a risk factor for COPD in this setting. The careful investigation of the determinants of COPD during routine diagnosis and care of people with HIV infection can aid the detection, further investigation, and improvement of the management of this group of patients.

Cited by 39 publications

References 23 publications

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

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

Bronchiectasis and other chronic lung diseases in adolescents living with HIV

Pulmonary effects of immediate versus deferred antiretroviral therapy in HIV-positive individuals: a nested substudy within the multicentre, international, randomised, controlled Strategic Timing of Antiretroviral Treatment (START) trial

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