People Living With HIV Have Slightly Higher Incidence of COPD, Study Confirms

By Will Boggs MD

February 21, 2020

NEW YORK (Reuters Health) - The incidence of chronic obstructive pulmonary disease (COPD) is slightly but significantly higher among people living with HIV than among HIV-negative people, and it may have to do with smoking, according to a retrospective study from Canada.

"Because we found women and men with HIV have higher rates of COPD than the general population, and that COPD was diagnosed at an earlier age, COPD should be considered in patients with HIV with respiratory symptoms and a history of smoking," Dr. Tony Antoniou of the Institute for Clinical Evaluative Sciences, Saint Michael's Hospital, and the University of Toronto told Reuters Health by email.

Several small studies have shown higher rates of COPD in people with HIV than in HIV-negative people even after adjustment for smoking, suggesting that immune and infectious factors may be involved in the pathogenesis of COPD in people with HIV.

Dr. Antoniou and colleagues used health administrative databases to compare the incidence of COPD in people with and without HIV in Ontario, where more than 40% of Canadians with HIV live.

The incidence of COPD per 1,000 person-years was significantly higher among people living with HIV (10.4) than among HIV-negative people (9.0), the researchers report in CMAJ Open.

In multivariable analysis, people living with HIV had an incidence of COPD 34% higher than that of HIV-negative people.

People with HIV and COPD were younger (mean, 49.7 years) than were HIV-negative people with COPD (mean, 62.2 years) and were less likely to be female (18.6% vs. 49.2%, respectively).

"This suggests that we should be thinking about COPD in our patients with HIV at younger ages to support prompt diagnosis and treatment," Dr. Antoniou said.

After adjusting for estimated prevalence rates of smoking among people with and without HIV, people with HIV were no longer at higher risk for COPD than HIV-negative people.

"Part of the problem is first understanding why the prevalence of smoking is so much higher in people with HIV than the general population, so that strategies can be developed or adapted accordingly," Dr. Antoniou said.

"Some studies have found that people with HIV report smoking to enhance their mood and deal with the anxiety of living with HIV. It could be that developing interventions which include mental health support and/or are delivered by peers may be more accepting and successful in people with HIV," he said. "Involving the community in understanding what would help support smoking cessation is likely the best way to develop programs that would work."

"Working with patients to support quitting smoking should become an increasing priority where possible," Dr. Antoniou said. "Given that recent studies show that smoking now accounts for more years of lost life among people with HIV who smoke than HIV itself, developing and funding interventions that facilitate quitting should be a priority for optimizing the long-term health of people with HIV."

SOURCE: CMAJ Open, online February 18, 2020.