Key Point

HIV-positive patients have a significantly elevated risk of COPD.

SEATTLE—Before the advent of highly active antiretroviral therapy (HAART), patients who were HIV positive were at increased risk for a host of opportunistic illnesses. These patients also developed emphysema at an accelerated rate compared to those who were HIV negative.

Currently, as a result of HAART, HIV-positive patients are living much longer. Are they thus vulnerable to diseases that previously they may not have survived long enough to develop? At the annual meeting of the American College of Chest Physicians, Kristina A. Crothers, MD, an Instructor in the Department of Pulmonary and Critical Care Medicine at Yale University in New Haven, reported on a study that she and her colleagues conducted in two patient groups with different HIV statuses: They observed a significantly greater incidence of COPD among the HIV-positive group.¹

Participants were enrolled in the multicenter Veterans Aging Cohort Study, which prospectively studied 895 HIV-positive and 653 HIV-negative patients. Smoking status (including pack-years smoked) and presence of physician-diagnosed obstructive lung disease were recorded via patient survey. Patients were also asked about coughing and respiratory symptoms.

Cigarette smoking was highly prevalent among all patients, regardless of their HIV status. Forty-five percent of HIV-positive patients were current smokers, compared with 36% of HIV-negative patients. Primarily because they were younger, HIV-positive patients had accumulated fewer pack-years than did HIV-negative patients.

As expected, risk of COPD increased with the number of pack-years smoked in both groups. However, HIV-positive smokers had a much greater risk of COPD than their HIV-negative counterparts. In fact, HIV infection was an independent risk factor for COPD—up to 50% greater for HIV-positive patients. Adjusting for age, race, and pack-years of smoking increased the risk to 59% for HIV-positive patients to have any type of obstructive lung disease.

Apparently, HIV-positive smokers have additional smoking-related health risks. Why this is so needs to be studied further. For example, the number of bacterial infections a person has is related to declining lung function. Thus, could HIV-related infections play a role in the development of COPD? Furthermore, does the inflammatory response in the lungs of an immunocompromised host differ from that of a person with normal immune function?

Increasing provider awareness of COPD in HIV-positive populations and “ordering spirometry or pulmonary function tests to diagnose patients with obstructive lung disease earlier might help in terms of motivating patients to stop smoking,” observed Dr. Crothers. “It also would allow earlier therapy to improve symptoms.”

—Gale Jurasek

Reference
1. Crothers KA. HIV infection is associated with increased chronic obstructive lung disease. Presented at: annual meeting of the American College of Chest Physicians; October 27, 2004; Seattle, Wash.

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