Prevalence of hepatitis C virus infection in patients with COPD

Association between viral hepatitis and metabolic syndrome in lung function impairment: A Taiwan community-based study

OBJECTIVES

Metabolic syndrome (MetS) and hepatitis C virus (HCV) are associated with a higher risk of impaired pulmonary function (iPF). This study aimed to investigate the relationships among MetS, iPF, and viral hepatitis.

METHODS

This community-based study enrolled participants undergoing annual health check-ups in southern Taiwan between March and December 2019. We performed multivariable logistic regression analyses adjusted for demographics and characteristics to identify the factors associated with iPF.

RESULTS

A total of 2337 participants completed examinations, of whom 928 (39.7%) had iPF. The participants with iPF were elderly (68.8  ±  12.8 years old) and predominately female (63%). MetS increased the risk of iPF (odds ratio (OR) 1.51, 95% confidence interval (CI) 1.27-1.81, p < 0.001). Beyond age (OR 1.03, 95% CI 1.02-1.04) and smoking (OR 1.309, 95% CI 1.004-1.705), female sex (OR 0.74, 95% CI 0.59-0.93) and high education level (OR 0.96, 95% CI 0.94-0.98, p < 0.001) protected against iPF. HCV was not significantly associated with iPF (OR 1.17, 95% CI 0.90-1.52, p  =  0.235) in multivariable analysis. MetS was associated with a higher risk of iPF in the non-HBV/HCV group (OR 1.86, 95% CI 1.54-2.26) and HBV alone group (OR 3.44, 95% CI 1.89-6.28), but not in the HCV alone group (OR 1.02, 95% CI 0.64-1.62).

DISCUSSION

MetS was an independent predictor of iPF, especially the restrictive type, and had different effects in the HBV/non-viral hepatitis and HCV groups. Female sex and education were inversely associated with iPF.

Chronic viral hepatitis accelerates lung function decline in smokers

Although hepatitis B virus (HBV) and hepatitis C virus (HCV) are hepatotrophic viruses, they may affect pulmonary diseases. The purpose of this study was to assess whether chronic viral hepatitis (CVH) infection was associated with a rapid decline in lung function. Repeated measurements of lung function were obtained from a well-curated health check-up database. A case was defined as an individual positive for HBsAg or anti-HCV antibody. A control was randomly selected (from the same dataset) after 1:1 matching in terms of age, sex, height, the body mass index, and smoking status. Separate analyses of non-smokers and smokers were performed. A total of 701 cases were enrolled (586 with HBV and 115 with HCV). In cross-sectional analysis, both forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) decreased significantly only in smokers (smoking cases vs. smoking controls) (adjusted p = 6.6 × 10-5 and adjusted p = 2.2 × 10-3, respectively). In longitudinal analysis, smoking cases showed significantly greater FEV1 and FVC decline rates than did smoking controls (adjusted p = 8.5 × 10-3 and adjusted p = 1.2 × 10-5, respectively). Such associations were particularly high in smoking cases at intermediate-to-high risk of hepatic fibrosis, as evaluated by the non-invasive Fibrosis-4 index. In summary, CVH was associated with both decreased lung function and accelerated lung function decline in smokers. A non-invasive measurement of hepatic fibrosis may be useful in predicting rapid lung function decline in smokers with CVH.

Comorbidities in patients with chronic hepatitis C and hepatitis B on hemodialysis

BACKGROUND AND AIM

Hemodialysis patients are at increased risk of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. Both HBV and HCV infections lead to risks of end-stage liver diseases and extrahepatic manifestations. This study aimed to investigate hepatic and extrahepatic comorbidities in hemodialysis patients with HBV or HCV infections compared with those without viral hepatitis.

METHODS

A total of 1910 hemodialysis patients, including 159 HCV viremic patients (HCV group), 217 seropositive for HBV surface antigen (HBsAg, HBV group) and 1534 seronegative for both anti-HCV and HBsAg (non-B and non-C [NBNC] group), from 23 hemodialysis centers were enrolled. Comorbidities were classified into 10 categories by the International Classification of Diseases-10th Revision.

RESULTS

Among the 1910 patients, the mean age was 64.6 years, and 52.7% were male patients. A total of 1834 (96%) patients had at least one comorbidity, and the mean number of comorbidities was 2.9 ± 1.5 per person. The three most common comorbidities were hypertension, diabetes, and ischemic heart diseases. The mean number of comorbidities per person was significantly higher in the HCV group (3.3 ± 1.7) than in the HBV (2.7 ± 1.5, P < 0.001) and NBNC groups (2.9 ± 1.5, P = 0.004), mainly due to the higher prevalence of ischemic heart disease, respiratory disorders, and mental/behavioral disorders. The HBV and NBNC groups exhibited comparable burdens of comorbidities.

CONCLUSIONS

Hemodialysis patients had a high prevalence of multiple comorbidities. Hemodialysis patients with HCV exhibited a higher burden of comorbidities, especially ischemic heart diseases, respiratory disorders, and mental/behavioral disorders, than HBV and NBNC patients did.

Subclinical Hepatitis C Virus Infection in Patients with Chronic Obstructive Pulmonary Disease: Evidence from a Cross-Sectional Multicenter Observation Study

Background: Patients with hepatitis virus C (HCV) infection have declined levels of forced expiratory volume (FEV), which is a prognostic marker for chronic obstructive pulmonary disease (COPD). Objectives: The current study primarily aimed to investigate the incidence of subclinical HCV infection (clinical signs are absent but positive HCV RNA test performed by polymerase chain reaction) in patients with COPD of Zhejiang province, China, and its secondary aim was to investigate the clinical influence of HCV infection on COPD severity by body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) scoring index and pulmonary function tests (PFT). Methods: A total of 252 patients with COPD (confirmed by routine lab tests, BODE index, and PFT) were included in a cross-sectional multicenter study. An anti-HCV antibody test was used to diagnose HCV infection. Hepatitis virus C RNA was tested for patients with a HCV antibody-positive test. Results: Twelve patients had a positive anti-HCV antibody test. Of 12 anti-HCV antibody positive test patients, 10 were positive for the HCV RNA. The prevalence of anti-HCV antibody positivity and HCV RNA positivity was 12/ 252 and 10/ 252, respectively. The partial arterial pressure of oxygen was the same for patients with HCV RNA positive test compared to those with a negative anti-HCV antibody test (59.70 ± 5.50 mmHg vs. 63.84 ± 15.63 mmHg, P = 0.791). Patients with a positive HCV RNA test had a higher partial arterial pressure of carbon dioxide compared to those with a negative anti-HCV antibody test (43.70 ± 1.89 mmHg vs. 49.42 ± 7.33 mmHg, P = 0. 007). BODE index was higher for patients with HCV RNA positive test than those with anti-HCV antibody test negative (6 (3 - 7) vs. 4 (2 - 6), P < 0.0001). Among the variables of BODE index scoring, the values of distance walked in 6 min (P < 0.0001) and % predicted forced expiratory volume in 1 s (P < 0.0001) were fewer for patients with HCV RNA positive test than those with a negative anti-HCV antibody test. Conclusion: This study demonstrated that subclinical HCV infection may be observed in COPD patients.

Assessing Infection Risks among Clients and Staff Who Use Tattooing Services in Poland: An Observational Study

Across cultures and generations, people have tattooed their bodies. Although blood-borne infections from tattooing have been reduced, certain service aspects remain improperly managed. We assessed the infection risks associated with tattooing by conducting a cross-sectional study (2013–2014) in Poland using an anonymous questionnaire survey. Scoring procedures for blood-borne infection risks for tattooists and their clients were used. Overall, 255 tattooists were interviewed. A quasi-random selection of tattoo parlors was based on a service register. Knowledge, attitudes, and behavior regarding blood-borne infection risks were assessed using a questionnaire. Simultaneously, tattoo centers were audited. Tattooing had a higher infection risk for tattooists than for clients. Approximately 50% of respondents underwent training on postexposure procedures, which constituted almost one in five of the reported needlestick/cut injuries sustained while working. Furthermore, 25.8% had no knowledge regarding risk from reliable sources, and 2.1% had not broadened their knowledge. Tattooists and their clients are at a risk of infection, and knowledge concerning infection risks remains an underestimated preventative factor. Service quality surveillance and creation of a register for tattoo-related complications may help assess the scale of this public health issue. However, a lack of these records implies the challenges in developing effective organizational and legal protections.

Chronic Hepatitis B Infection in Children and Its Relation to Pulmonary Function Tests: A Case-control Study

BACKGROUND

The aim of this study was to evaluate the pulmonary function test (PFT) abnormalities, if any, in children with newly diagnosed chronic hepatitis B (CHB) infection over 3 years.

METHODS

This is an observational case-control study. One hundred children and adolescents with newly diagnosed CHB were enrolled as the patient group that was further subdivided into 2 groups (50 patients each): inactive carriers (group I) and patients in immunotolerant phase (group II). Only 90 patients completed the study. Fifty healthy children of matched age, sex and height served as a control group, only 45 of them completed the study. PFTs in the form of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, residual volume, total lung capacity, mid-forced expiratory flow of 25%-75% and diffusing capacity of the lung for carbon monoxide were evaluated in all studied children at the start, yearly and at the end of the study after 3 years. Liver function tests were also evaluated.

RESULTS

There was a significant progressive decrease in FEV1, FVC, forced expiratory flow, total lung capacity and diffusing capacity of the lung for carbon monoxide in CHB patient groups compared with their pulmonary functions at the start of the study and with the control group (P < 0.05), while FEV1/FVC and residual volume showed nonsignificant change (P > 0.05).

CONCLUSIONS

Subclinical PFT abnormalities are present in children with CHB more than we expected. So, PFT monitoring is recommended in pediatric patients with CHB.

Chronic Obstructive Pulmonary Disease and Hepatitis C

Chronic obstructive pulmonary disease (COPD) is a preventable, treatable disease with significant extrapulmonary manifestations that could affect negatively its course in some patients. Hepatitis C virus infection (HCV), on the other hand, is associated with a number of extrahepatic manifestations. COPD patients have increased prevalence of HCV and patients with HCV, especially older ones, have increased prevalence and faster progression of COPD. HCV infection exerts long-term effects on lung tissue and is an additional risk factor for the development of COPD. The presence of HCV is associated with an accelerated loss of lung function in COPD patients, especially in current smokers. COPD could represent extrahepatic manifestation associated with HCV infection. The aim of this article was to review the literature on prevalence of HCV in COPD and vice versa, pathogenetic link and the consequences of their mutual existence.

Decreased Lung Function and All-Cause Mortality in HIV-infected Individuals

RATIONALE

Human immunodeficiency virus (HIV) infection is associated with pulmonary disease and worse lung function, but the relationship of lung function with survival in HIV is unknown.

OBJECTIVES

To determine whether lung function is associated with all-cause mortality in HIV-infected individuals.

METHODS

HIV-infected participants from cohorts in three locations underwent pre- and post-bronchodilator spirometry and determination of single-breath diffusing capacity of the lung for carbon monoxide (Dl_CO) in 2008-2009, computed tomographic (CT) scanning of the chest for quantitative emphysema and airway measures, and echocardiography for estimated left ventricular systolic and diastolic function and tricuspid regurgitant velocity. Bivariate analysis and multivariable Cox proportional hazards models were used to determine whether decreased lung function was independently associated with increased all-cause mortality. Models were adjusted for covariates including age, sex, body mass index, smoking status, self-reported hepatitis C status, HIV viral levels, CD4⁺ T-cell counts, hemoglobin, antiretroviral therapy, and illicit drug use.

RESULTS

Overall, 396 HIV-infected participants underwent pulmonary function testing. Thirty-two participants (8%) died during a median follow-up period of 69 months. A post-bronchodilator FEV₁-to-FVC ratio less than 0.7 (hazard ratio [HR], 2.47; 95% confidence interval [CI], 1.10-5.58) and a Dl_CO less than 60% (HR, 2.28; 95% CI, 1.08-4.82) were independently associated with worse mortality. Also, hepatitis C (HR, 2.68; 95% CI, 1.22-5.89) and baseline plasma HIV RNA level (HR per ln RNA copies/ml, 1.50; 95% CI, 1.22-1.86) were associated with mortality in HIV-infected participants. The only CT or echocardiographic measure associated with greater mortality in univariate analysis was greater wall thickness of medium-sized airways (HR for wall area percent, 1.08; 95% CI, 1.00-1.18; P = 0.051), but none of the CT or echocardiogram measures were associated with mortality in multivariable analysis.

CONCLUSIONS

Airflow obstruction and impaired diffusing capacity appear to be associated with all-cause mortality in HIV-infected persons over an average of 6 years of follow-up. These data highlight the importance of lung dysfunction in HIV-infected persons and should be confirmed in larger cohorts and with extended follow-up periods. Clinical trial registered with www.clinicaltrials.gov (NCT00869544, NCT01326572).

Non-specific impairment of Lung Function on Spirometery in Patients with Chronic Hepatitis-C

Objectives:

To document frequency of non-specific impairment of lung functions (NILF) in patients of HCV and to compare according to gender, genotype, liver fibrosis score and smoking status.

Methods:

Patients of chronic hepatitis C were included after informed consent. Demographic data was recorded, and they underwent baseline investigations, fibroscan, abdominal ultrasound and PFT. Patients were segregated on basis of gender, fibroscan stages and smoking status. NILF was labelled if any two of three criteria are fulfilled (a) FVC < 80% of Predicted, (b) FEV1 < 80% Predicted, (c) FEV1/FVC ≥ 70.

Results:

Two hundred thirty four patients were of chronic HCV who fulfilled the selection criteria were inducted in study. These included 49.6% males and 50.4% females. There were 15.0% smokers, 16.2% were ex-smokers while 68.8% were never smokers. NILF was present in 130 (55.6%) out of which 61.5% were female and 38.5% were male (p <0.001), its presence in smokers was 56.2% and in never smokers was 55.3% (p=0.507). Presence of NILF increased with Fibroscan stages from F1 to F4 (p <0.001).

Conclusions:

NILF pattern on spirometry with normal chest radiograph is common among HCV patients. It was found more common in females and frequency increased progressively with fibro scan stages.

Hepatitis C Screening in Commercially Insured U.S. Birth-cohort Patients: Factors Associated with Testing and Effect of an EMR-based Screening Alert

BACKGROUND AND OBJECTIVES

Hepatitis C virus (HCV) testing rates among U.S. birth-cohort patients have been studied extensively, limited data exists to differentiate birth-cohort screening from risk- or liver disease-based testing. This study aims to identify factors associated with HCV antibody (HCV-Ab) testing in a group of insured birth cohort patients, to determine true birth cohort testing rates, and to determine whether an electronic medical record (EMR)-driven Best Practice Alert (BPA) would improve birth cohort testing rates.

METHODS

All birth-cohort outpatients between 2010 and 2015 were identified. HCV-Ab test results, clinical, and demographic variables were extracted from the EMR, and factors associated with testing were analyzed by logistic regression. True birth-cohort HCV screening rates were determined by detailed chart review for all outpatient visits during one calendar month. An automated Best Practice Alert was used to identify unscreened patients at the point of care, and to prompt HCV testing. Screening rates before and after system-wide implementation of the BPA were compared.

RESULTS

The historic HCV-Ab testing rate was 11.2% (11,976/106,753). Younger age, female gender, and African American, Asian, or Hispanic ethnicity, and medical comorbidities such as chronic hemodialysis, HIV infection, and rheumatologic and psychiatric comorbidities were associated with higher testing rates. However, during the one-month sampling period, true age cohort-based testing was performed in only 69/10,089 patients (0.68%). Following the system-wide implementation of the HCV BPA, testing rates increased from 0.68% to 10.76% (P<0.0001).

CONCLUSIONS

We documented low HCV-Ab testing rates in our baby boomers population. HCV testing was typically performed in the presence of known risk factors or established liver disease. The implementation of an EMR-based HCV BPA resulted in a marked increase in testing rates. Our study highlights current HCV screening gaps, and the utility of the EMR to improve screening rates and population health.

Chronic obstructive pulmonary disease and comorbidities: a large cross-sectional study in primary care

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is common, and a major cause of morbidity and mortality worldwide. Recent studies suggest that comorbidities of COPD increase the risk of hospitalisation, polypharmacy, and mortality, but their estimated prevalence varies widely in the literature.

AIM

To evaluate the prevalence of 38 physical and mental health comorbidities in people with COPD, and compare findings with those for people without COPD in a large nationally representative dataset.

DESIGN AND SETTING

A cross-sectional data analysis on 1 272 685 adults in Scotland from 314 primary care practices.

METHOD

Data on COPD, along with 31 physical and seven mental health comorbidities, were extracted. The prevalence of comorbidities was compared between people who did, and did not, have COPD, standardised by age, sex, and socioeconomic deprivation.

RESULTS

From the total sample, 51 928 patients had COPD (4.1%). Of these, 86.0% had at least one comorbidity, compared with 48.9% of people without COPD. Of those with COPD, 22.3% had ≥5 comorbid conditions compared with 4.9% of those who did not have COPD (adjusted odds ratio 2.63, 95% confidence interval = 2.56 to 2.70). In total, 29 of the 31 physical conditions and six of the seven mental health conditions were statistically significantly more prevalent in people who had COPD than those who did not.

CONCLUSION

Patients with COPD have extensive associated comorbidities. There is a real need for guidelines and health care to reflect this complexity, including how to detect those common comorbidities that relate to both physical and mental health, and how best to manage them. Primary care, which is unique in terms of offering expert generalist care, is best placed to provide this integrated approach.

Hepatitis C Virus-Associated Extrahepatic Manifestations in Lung and Heart and Antiviral Therapy-Related Cardiopulmonary Toxicity

Besides liver cirrhosis and hepatocellular carcinoma, chronic hepatitis C virus (HCV) infection is associated with many extrahepatic manifestations (EHMs). HCV exhibits lymphotropism that is responsible for various EHM. An important characteristic of HCV is escape from the immune system, which enables it to produce chronic infections and autoimmune disorders along with accumulation of circulating immune complexes. These EHMs have large spectrum, because they affect many organs such as heart, lungs, kidney, brain, thyroid, and skin. HCV-related cardiac and pulmonary manifestations include myocarditis, cardiomyopathies, cardiovascular diseases (i.e., Stroke, ischemic heart disease), chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, asthma, and interstitial lung diseases. This review discusses etiology and pathogenesis of HCV-associated cardiac and pulmonary manifestations and how different genes, immune system, indirectly linked factors (mixed cryoglobulinemia), liver cirrhosis, and antiviral treatment are involved in HCV-related heart and lung diseases, however, their exact mechanism is not clear.

Other Extrahepatic Manifestations of Hepatitis C Virus Infection (Pulmonary, Idiopathic Thrombocytopenic Purpura, Nondiabetes Endocrine Disorders)

Extrahepatic manifestations of hepatitis C virus (HCV) infection are a rare but serious condition. This article summarizes the current literature on the association between HCV and endocrine and pulmonary manifestations, as well as idiopathic thrombocytopenic purpura (ITP). HCV may directly infect extrahepatic tissues and interact with the immune system predisposing for obstructive and interstitial lung disease, ITP, autoimmune thyroiditis, infertility, growth hormone and adrenal deficiencies, osteoporosis, and potentially lung and thyroid cancers. However, in many cases, the current evidence is divergent and cannot sufficiently confirm a true association, which emphasizes the need for future targeted projects in this field.

Trends in Epidemiology of COPD in HIV-Infected Patients in Spain (1997-2012)

Purpose

The aim of this study was to estimate trends of incidence of hospital admissions and in-hospital mortality (IHM) in HIV-infected patients with COPD in the combination antiretroviral therapy (cART) era in Spain (1997–2012).

Methods

A retrospective study with data from nationwide population-based COPD diagnoses in the Spanish Minimum Basic Data Set (MBDS) was performed. We established groups according to their HIV and HCV infections: 1) HIV-uninfected patients; 2) HIV-infected patients (with or without HCV coinfection).

Results

1,580,207 patients discharge with a COPD diagnosis were included in the study, 8902 of them were HIV-infected patients (5000 HIV-monoinfected patients and 3902 HIV/HCV-coinfected patients). The HIV-infected patients had higher incidence rates of hospital admissions for COPD than the HIV-uninfected patients during the study period. The HIV-monoinfected patients had higher rates of hospitalizations for COPD than the HIV/HCV-coinfected patients in the early-period cART (1997–1999), but these rates decreased in the first group and increased in the second, being even similar in both groups in the late-period cART (2004–2011). On the other hand, the HIV-infected patients with COPD had higher IHM than the HIV-uninfected patients with COPD. The mortality rates were higher in the HIV-monoinfected patients with COPD than in the HIV/HCV-coinfected patients with COPD in the early-period cART; however, in the late-period cART, the mortality rates trends seems higher in the HIV/HCV group. The likelihood of death in HIV/HCV-coinfected patients with COPD was similar to than in HIV-monoinfected patients with COPD.

Conclusions

Incidence of hospital admissions for COPD and IHM have decreased among HIV-monoinfected individuals but have increased steadily among HIV/HCV-coinfected individuals in the cART era.

The association of exposure to hepatitis B and C viruses with lung function and respiratory disease: a population based study from the NHANES III database

BACKGROUND

Globally, 500 million people are chronically infected with Hepatitis B virus (HBV) and Hepatitis C virus (HCV). While these viruses are notorious for their detrimental effect on the liver they are also known to affect multiple organs in the body including the lungs.

AIM

To investigate if exposure to HBV and HCV is associated with lung function and respiratory diseases.

METHODS

Data from the Third National Health and Nutrition Examination Survey (NHANES III) was analysed using multiple linear regressions to investigate the association between exposure to HBV and HCV with the various measures of lung function, while multiple logistic regressions were used to evaluate the association with the respiratory diseases asthma and chronic obstructive pulmonary disease (COPD).

RESULTS

Exposure to HCV was significantly associated with an increase in Forced Expiratory Volume in 1 s, FEV1 (Coef: 97.94 ml, 95% CI: 38.87 to 157.01) and Full Vital Capacity, FVC (Coef: 90 ml, 95% CI: 14.50 to 166.24). Individuals who had been exposed to both HBV and HCV also had a significantly higher FEV1 (Coef: 145.82, CI: 60.68 to 230.94) and FVC (Coef: 195.09, CI: 78.91 to 311.26). There was also a significant association between exposure to HBV and asthma (OR: 1.28, 95% CI: 1.05 to 1.58). These associations were no longer significant after additionally adjusting for cocaine and marijuana use as well as poverty income ratio.

CONCLUSION

Our research implies that hepatotropic viruses may affect the respiratory system, but more work at a population level is needed to further explore these associations.

Hepatitis C virus infection is not an independent risk factor for obstructive lung disease

Several epidemiological studies have suggested that hepatitis C virus (HCV) infection is associated with the presence of obstructive lung disease (OLD). However, there is a strong link between HCV infection and tobacco abuse, a major risk factor for the development of OLD. In this study we analyzed clinical, laboratory and spirometric data from 1068 study participants to assess whether HCV infection, viremia, or HCV-associated end organ damage were associated with OLD. Demographics, risk behavior, serologic status for HCV and HIV, and spirometric measurements were collected from a cross-sectional analysis of the Acquired Immunodeficiency Syndrome (AIDS) Linked to the IntraVenous Experience (ALIVE) study, an observational cohort of IDUs followed in Baltimore, MD since 1988. Of 1,068 participants, 890 (83%) were HCV positive and 174 (16%) met spirometric criteria for OLD. Factors independently associated with OLD were age and BMI. HCV infection, viral load and HCV-associated end organ damage were similar in participants with and without OLD. In summary, there was no independent association between markers of HCV exposure, chronicity, viremia, or HCV-associated end-organ damage with OLD. Our findings support the strong correlation between HCV status, injection drug use, and smoking. These data suggest that HCV may not be a sole contributor to the increased prevalence of OLD described in previous studies of HCV-infected individuals.

HIV infection is associated with diffusing capacity impairment in women

Respiratory dysfunction is common with HIV infection, but few studies have directly assessed whether HIV remains an independent risk factor for pulmonary function abnormalities in the antiretroviral therapy era. Additionally, few studies have focused on pulmonary outcomes in HIV+ women. We tested associations between risk factors for respiratory dysfunction and pulmonary outcomes in 63 HIV+ and 36 HIV-uninfected women enrolled in the Women's Interagency HIV Study. Diffusing capacity (DL(CO)) was significantly lower in HIV+ women (65.5% predicted vs. 72.7% predicted, P = 0.01), and self-reported dyspnea in HIV+ participants was associated with both DL(CO) impairment and airflow obstruction. Providers should be aware that DL(CO) impairment is common in HIV infection, and that either DL(CO) impairment or airflow obstruction may cause respiratory symptoms in this population.

The influence of virus infections on the course of COPD

Chronic obstructive pulmonary disease (COPD) is extensively influenced by viral infections. The mechanisms of how viral agents affect the pathogenesis and prognosis of COPD are numerous. In general, patients with infectious exacerbations are characterized by longer hospitalization periods and greater impairment of several lung function parameters than those with non-infectious exacerbations. Prodromal, clinical, and outcome parameters fail to distinguish virally from non-virally induced illnesses in cases of exacerbations. The importance of infections with respiratory and non-respiratory viral agents for pathogenesis and course of COPD is detailed. Human adenovirus, non-respiratory viruses including human immunodeficiency virus, human metapneumovirus, influenza virus, human rhinovirus, and respiratory syncytial virus are especially stressed.

Association between obstructive lung disease and markers of HIV infection in a high-risk cohort

BACKGROUND

Evidence suggests an association between HIV infection and the presence of obstructive lung disease (OLD). However, the associations between specific markers of HIV infection and OLD remain unclear. A study was undertaken to determine the independent associations of HIV infection, CD4 cell count and plasma HIV viral load with the presence of OLD in an urban cohort.

METHODS

Clinical, laboratory and spirometric data from the AIDS Linked to the Intravenous Experience (ALIVE) study, an observational study of current and former injection drug users in Baltimore, Maryland, were analysed. Multivariable logistic regression models were generated to identify HIV infection indices independently associated with OLD.

RESULTS

Of 1077 participants (mean±SD age 48±8 years), 89% were African-American, 65% were men and 86% were current smokers. A total of 303 (28%) were HIV infected and 176 (16%) had spirometry-defined OLD. Higher viral load was independently associated with OLD. HIV-infected individuals with viral load >200,000 copies/ml had a 3.4-fold increase in the odds of OLD compared with HIV-negative participants (95% CI 1.24 to 9.39; p=0.02). The association between higher HIV viral load and OLD persisted after accounting for antiretroviral therapy use (OR 4.06, 95% CI 1.41 to 11.7; p=0.01). No association was observed between HIV serostatus or CD4 cell count and the presence of OLD.

CONCLUSION

In a cohort at risk for OLD and HIV infection, high viral load but not CD4 cell count was associated with an increased prevalence of spirometry-defined OLD. These findings suggest that higher viral load may contribute mechanistically to the increased risk of OLD in patients with HIV infection.

High COPD prevalence in patients with liver disease

OBJECTIVE

Comorbidities of chronic obstructive pulmonary disease (COPD) have been recognized as an important issue in COPD management. We have reported that patients with liver diseases show a higher prevalence of COPD, but the number of patients with liver diseases was small and the details of liver diseases were not clearly investigated. In this study, we investigated the prevalence of COPD in patients with liver diseases by recruiting a large number of patients, and also investigated was the effect of hepatitis virus infection on COPD prevalence.

PATIENTS AND METHODS

Six hundred sixty-six patients were recruited from 9 primary care clinics and three hospitals. All of these patients were aged 40 years or older with chronic diseases and had not been diagnosed as having respiratory diseases. A spirometry was performed without administration of an inhaled bronchodilator. Airflow limitation was defined as FEV1/FVC<70%. Underlying diseases were diagnosed by doctors of the clinics or the hospitals.

RESULTS

Two hundred fifty-six patients had liver diseases, and 410 did not. Of 410 patients without liver diseases, 37 patients (9.0%) were diagnosed as COPD, and of 256 patients with liver diseases, 35 patients (13.8%) were COPD. When the prevalence was analyzed according to smoking, age and gender, liver diseases showed a significantly high odds ratio (2.10, 95%CI 1.23-3.57, p=0.006), but hepatitis virus infection showed a non-significant tendency toward a high odds ratio.

CONCLUSION

The patients with liver diseases had a significantly high prevalence of COPD. The presence of liver disease might become a useful predictor for the early detection of COPD.