Screening for Chronic Obstructive Pulmonary Disease (COPD) in an Urban HIV Clinic: A Pilot Study

Abstract

Increased smoking and a detrimental response to tobacco smoke in the lungs of HIV/AIDS patients result in an increased risk for COPD. We aimed to determine the predictive value of a COPD screening strategy validated in the general population and to identify HIV-related factors associated with decreased lung function. Subjects at least 35 years of age at an HIV clinic in New York City completed a COPD screening questionnaire and peak flow measurement. Those with abnormal results and a random one-third of normal screens had spirometry. 235 individuals were included and 89 completed spirometry. Eleven (12%) had undiagnosed airway obstruction and 5 had COPD. A combination of a positive questionnaire and abnormal peak flow yielded a sensitivity of 20% (specificity 93%) for detection of COPD. Peak flow alone had a sensitivity of 80% (specificity 80%). Abnormal peak flow was associated with an AIDS diagnosis ( p = 0.04), lower nadir ( p = 0.001), and current CD4 counts ( p = 0.001). Nadir CD4 remained associated in multivariate analysis (p = 0.05). Decreased FEV1 ( < 80% predicted) was associated with lower CD4 count nadir ( p = 0.04) and detectable current HIV viral load ( p = 0.01) in multivariate analysis. Questionnaire and peak flow together had low sensitivity, but abnormal peak flow shows potential as a screening tool for COPD in HIV/AIDS. These data suggest that lung function may be influenced by HIV-related factors.

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

“…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.…”

“…The implication of CD4 T-cell count in the pathogenesis of OLD as been suggested in the literature [10,11,36,37]. In two recent studies, Drummond and Shirley have shown an accelerated decline of respiratory function (forced expiratory volume in one second (FEV1) and forced vital capacity (FVC)) in HIV-infected people with lower CD4 cell counts [18,20]. In his cohort of 303 HIV-infected patients, Drummond observed, contrary to our results, that this association with CD4 cell count disappeared after adjustment for HIV viral load suggesting that HIV viral load was more determinant in respiratory decline than CD4 cell level [18].…”

“…In addition to known risk factors for COPD (tobacco smoking, age and body mass index), involvement of HIV-specific risk factors remains suspected. To date, studies assessing specific associations between HIV markers and HIV related parameters with COPD have yield contradictory results [12,13,16–20]. In order to explore this association, we studied, in a large cohort of HIV-infected outpatients, the prevalence of COPD and the related factors including all the factors previously tested in the literature between HIV and COPD.…”

Implementation of a COPD Screening Questionnaire in an Outpatient HIV Clinic

“…Tools validated in the general population, such as the COPD-Population Screener (PS) Questionnaire screening questionnaire (13), have low sensitivity (20%) and specificity (79%) when applied to an HIV population (20), underscoring the need for an HIV-specific COPD screening tool. Our tool includes factors common to the validated tools available for COPD screening in the general population and was streamlined to improve efficiency in a busy clinic providing longitudinal HIV care.…”

Maintaining lung health with longstanding HIV

“…Whether this lack of detection is due to poor physician awareness is not clear, but one barrier may be that screening often requires referral and evaluation elsewhere (108). The use of readily-available screening tools like peak flow, with or without symptom questionnaires, may be an approach that identifies those who need spirometry (109), but there remains a lack of prospective trials to guide an evidence-based approach to COPD screening in the HIV clinic.…”