Kate Johnson

September 22, 2014

WASHINGTON, DC — Chronic obstructive pulmonary disease (COPD) is a common yet under-recognized problem in patients with HIV and should be screened for regularly, according to a new study.

"There is a high prevalence of this preventable and largely undiagnosed disease, and we want to alert clinicians to improve COPD screening in this particular population," lead investigator Karine Risso, MD, from the Centre Hospitalier Universitaire de Nice in France, told Medscape Medical News.

The findings were presented here at the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy.

The study identified 6 key risk factors that can double to quadruple the risk for COPD in the HIV-positive population. This includes the observation, not previously reported, that a low CD4 count increases the risk for COPD, Dr. Risso explained.

The cross-sectional study involved 581 HIV-positive patients whose mean age was 48 years. All patients were seen in the infectious consultation department of the hospital during 3 randomly selected days each week. All were free from any recent lower respiratory tract infection.

The majority of patients, 93.5%, were receiving highly active antiretroviral therapy, 85.2% had an undetectable HIV viral load, and most patients were current or past smokers. The mean CD4 cell count was 622 cells/mm³.

Patients were screened with a questionnaire and hand-held spirometer, and then underwent conventional spirometry, including a bronchodilator test to exclude asthma.

The prevalence of COPD was 9.0%. Chronic bronchitis was reported by 7.7% of patients, recurrent acute bronchitis was reported by 8.6%, and dyspnea was reported by 17.2%

"COPD was common but largely unknown, despite the frequency of smoking and respiratory complaints and the international guidelines for COPD screening," said Dr. Risso.

In addition to age, body mass index (BMI), smoking, and respiratory complaints, which are all known risk factors for COPD, the researchers found that a CD4 count below 500 cells/mm³ more than doubled the risk for COPD (odds ratio [OR], 2.19; = .027).

Linked to Decreased CD4 Count

"This is only an epidemiological study — further studies are now necessary to verify and explain these results — but we can cite 2 possible mechanisms for this finding," Dr. Risso explained.

In addition to the link between a low CD4 count, chronic inflammation, and accelerated aging, some studies have shown a link between a low CD4 count and bronchial colonization with Pneumocystis jiroveci, she noted.

Also predictive of COPD risk were age over 50 years (OR, 2.37), a BMI below 21 kg/m² (OR, 4.07), current or past smoking (OR, 3.40), respiratory symptoms such as chronic bronchitis, recurrent acute bronchitis, or dyspnea (OR, 3.49), and previous lower respiratory tract infection (OR, 2.73).

"We want to alert clinicians to the burden of smoking and respiratory complaints in the HIV-infected population and the urgency to improve COPD diagnosis and management," Dr. Risso explained. "We now want to test our 6 predictive factors in a large cohort to evaluate their capacity to improve COPD screening. We hope that a clinical score could be created thanks to this study and others."

Asked by Medscape Medical News to comment on the study, Emily Blumberg, MD, from the University of Pennsylvania in Philadelphia, who was not involved in the research, said, "I think it's a very important observation and probably has worldwide significance."

"It's important to realize that patients with HIV are no longer dying of HIV, they're dying of all these comorbidities," she added. "Something like COPD, especially in a community with such high smoking rates, is really critical to be aware of. I think it's a wonderful thing to identify the risk factors and target these patients for interventions. It has to be further defined, but it's worth proceeding with," Dr. Blumberg explained.

Dr. Risso has disclosed no relevant financial relationships. Dr. Blumberg has worked with Pfizer, Bristol-Myers Squibb, ViroPharma, Cubist, Achaogen, Ansun, and Actelion.

54th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC): Abstract H-1196. Presented September 7, 2014.

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