Will expanded ART use reduce the burden of HIV-associated chronic lung disease?

Abstract

Purpose of Review The pulmonary complications of chronic HIV infection have shifted from infectious complications towards non-infectious pulmonary complications, predominantly chronic obstructive pulmonary disease (COPD). While the best-established COPD risk factor is cigarette smoking, emerging data suggest HIV infection also independently increases COPD risk. The purpose of this article is to review these data and the conflicting data regarding the role of antiretroviral therapy (ART) in modifying COPD risk. Recent Findings Observational studies favor HIV as an independent risk factor for COPD, particularly when viral load is high. The mechanisms underlying these associations are unclear, but untreated HIV infection is associated with pulmonary inflammatory responses similar to those seen in non-HIV COPD. ART reduces this pulmonary inflammation, but the clinical benefit of such reduction is unknown. Some observational studies suggest that ART users are at lower risk of COPD, while other studies suggest the opposite. Summary The effect of ART in causing COPD or reducing COPD risk is unknown, but is currently being tested in a randomized trial. Smoking cessation should remain of high priority.

Community-acquired bacterial pneumonia in adult HIV-infected patients

“…The same authors also reported that higher CD4 counts and undetectable viral loads were protective factors for CAP in the multivariate analysis, as were pneumococcal and influenza vaccinations. Despite effective ART, bacterial CAP is still frequent in HIV-A c c e p t e d M a n u s c r i p t infected patients (17,18), and mortality rates may be rising due to the prevalence of comorbidities in CAP patients (19). A prospective study(7) analyzing more than 18,000 patients in 34 countries over the period 2006 to 2011 reported a pneumonia incidence of 0.53 cases/100 person-years.…”

“…We recommend that such patients do not need treatment, admission, or care sites that differs from that of the general population. 13,14,15,17,18,19,20,22,23,24,25,27,28,29,30,62,63,66,67,68,70,71 A c c e p t e d M a n u s c r i p t…”

Using the Pathogenic and Nonpathogenic Nonhuman Primate Model for Studying Non-AIDS Comorbidities

“…With the advent of ART and the improvement of the immune status in patients receiving ART, infectious complications of AIDS are now better controlled. Currently, noninfectious lung diseases, like chronic obstructive pulmonary disease (COPD), are emerging as key clinical conditions [ 85 ].…”

Processing of Bronchoalveolar Lavage Fluid and Matched Blood for Alveolar Macrophage and CD4⁺ T-cell Immunophenotyping and HIV Reservoir Assessment

“…Even in the modern ART era, persons with HIV are at a greater risk of developing both infectious and noninfectious pulmonary diseases than persons without HIV. For example, persons with HIV infection are at elevated risk for invasive Streptococcal pneumoniae infection, as well as chronic obstructive pulmonary disease (COPD) 5,6 . Furthermore, coinfection of tuberculosis (TB) and HIV is a significant public health challenge in certain regions of the world, notably, sub-Saharan Africa, as HIV-infected individuals are 16 to 27 times more likely to have TB than persons without HIV 7 .…”

“…Although some explanations for this susceptibility to pulmonary infection and chronic disease have been proposed 8,9,10 , the precise cellular mechanisms by which individuals with suppressed HIV plasma viral load remain at higher risk for pulmonary complications have not been fully elucidated. Importantly, HIV is a very strong risk factor for pulmonary infection and chronic disease, independent of smoking status 6 .…”