Risk factors associated with acute exacerbation of chronic obstructive pulmonary disease in HIV-infected and uninfected patients

Abstract

Objective To determine the association between HIV infection and other risk factors for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Design Longitudinal, national Veterans Aging Cohort Study (VACS) including 43,618 HIV-infected and 86,492 uninfected Veterans. Methods AECOPD was defined as an inpatient or outpatient COPD ICD-9 diagnosis accompanied by steroid and/or antibiotic prescription within 5 days. We calculated incident rate ratios [IRR] and 95% confidence intervals (CI) for first AECOPD over 2 years and used Poisson regression models to adjust for risk factors. Results Over 234,099 person-years of follow-up, 1,428 HIV-infected and 2,104 uninfected patients had at least one AECOPD. HIV-infected patients had an increased rate of AECOPD compared with uninfected (18.8 vs. 13.3 per 1000 person-years, p<0.001). In adjusted models, AECOPD risk was greater in HIV-infected individuals overall (IRR 1.54; 95% CI 1.44 – 1.65), particularly in those with more severe immune suppression when stratified by CD4 cell count (cells/mm3) compared to uninfected (HIV-infected CD4<200: IRR 2.30, 95% CI 2.10-2.53, HIV-infected CD4 ≥200-349: IRR 1.32, 95% CI 1.15-1.51, HIV-infected CD4≥350: IRR 0.99, 95% CI 0.88-1.10). HIV infection also modified the association between current smoking and alcohol-related diagnoses with risk for AECOPD such that interaction terms for HIV and current smoking or HIV and alcohol-related diagnoses were each significantly associated with AECOPD. Conclusions HIV infection, especially with lower CD4 count, is an independent risk factor for AECOPD. Enhanced susceptibility to harm from current smoking or unhealthy alcohol use in HIV-infected patients may also contribute to the greater rate of AECOPD.

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.…”

Incidence of chronic obstructive pulmonary disease in people with HIV in Ontario, 1996–2015: a retrospective population-based cohort study

“…Early diagnosis and intervention aimed at preventing loss of lung function may be particularly important for people with HIV and COPD, as several studies suggest that hospital admissions and emergency department use related to COPD are more common in this population relative to HIV-negative people with COPD. 37,38 Second, efforts to identify and implement smoking cessation strategies acceptable to people with HIV are required. Prior research has shown that smoking now accounts for more years of lost life among people with HIV who smoke than HIV infection itself.…”

Markers of chronic obstructive pulmonary disease are associated with mortality in people living with HIV

“…[48,49] Those who are admitted with COPD-related diagnoses may face higher in-hospital mortality. [50] PLWH may also experience an accelerated decline in pulmonary function.…”