Chronic obstructive pulmonary disease in adults with human immunodeficiency virus infection: a systematic review

Abstract

Objective: To determine the prevalence of chro- nic obstructive pulmonary disease (COPD) in adults with Human Immunodeficiency virus infection (HIV). Design: Systematic review of Medline, Embase, CINAHL, PsycINFO and references from identified papers. Study selection: Studies determining the prevalence of COPD in adults with HIV infection. Independent duplicate data extraction. Study quality was assessed in terms of whether consecutive patients were en- rolled, recruitment and follow-up periods were defined, <10% of subjects were lost to follow-up, subjects with missing data, method of COPD diagnosis and antiretroviral treatment were described. Data synthesis and results: Of the 911 citations identified, 8 North American studies conducted from 2005 to 2010 were reviewed. The demographics were: mean age 43 - 50.3yrs, >60% males, <50% African Americans, 37.1% - 83.3% active smokers, >60% on antiretroviral therapy. COPD was diagnosed by post-bronchodilator FEV1/FVC < 0.7 in three studies, by International Classification of Diseases (ICD-9) codes in three studies, by FEV1/FVC < 5% of lower adjusted normal in one and by pre- bronchodilator FEV1/FVC < 0.7 in another study. The prevalence was 10% - 35%, except for one study that recorded prevalence of 4% by postbronchodilator FEV1/FVC < 0.7, but <38% of patients with prebronchodilator FEV1/FVC < 0.7 had post-bronchodilator spirometry in that study. Conclusion: COPD is becoming increasingly common in HIV infected as they smoke and live longer due to efficient antiretrovirals. However, definite conclusions cannot be drawn and more longitudinal studies are needed. In the meantime health care providers should be vigilant to screen for undiagnosed COPD and hesitant to attribute respiratory symptoms solely to HIV infection.