1
|
Abdo M, Kunisaki KM, Morris A, Stosor V, Chang D, D'Souza G, Crothers K, Abdel-Maksoud M, DiGuiseppi C, Brown TT, Erlandson KM, MaWhinney S. Pulmonary Function and Quality of Life in Aging Men With and Without HIV from the Multicenter AIDS Cohort Study. AIDS Res Hum Retroviruses 2023; 39:621-632. [PMID: 37276144 PMCID: PMC10712368 DOI: 10.1089/aid.2023.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
People living with HIV have greater pulmonary function impairments and decreased health-related quality of life (HRQoL) compared to uninfected peers. We examined whether pulmonary impairment was associated with HRQoL or respiratory health status. Using Multicenter AIDS Cohort Study data (2017-2019), associations between outcomes [HRQoL (36-Item Short Form Survey) and respiratory health status (St. George's Respiratory Questionnaire)] with pulmonary impairment [diffusing capacity for carbon monoxide (DLCO) and forced expiratory volume in 1 s (FEV1), defined as <80% predicted for both] were examined. Adjusted analyses utilized linear and zero-inflated beta regression, the latter summarized by odds ratio (OR) and quotient ratios (QRs). We also considered whether the subset of adjustment variables age, HIV serostatus, or smoking modified the relationships examined. Of 1048 men, 55% had HIV, with median age 57 [interquartile range (IQR) = 48, 64] years and 1.2 (IQR = 0, 18.1) smoking pack-years. Impaired DLCO, but not impaired FEV1, was significantly associated with lower physical HRQoL [-2.71 (-4.09, -1.33); -1.46 (-3.45, 0.54), respectively]. Pulmonary impairment was associated with higher odds of any St. George's Respiratory Questionnaire (SGRQ) (total score) limitation [DLCO OR = 1.53 (1.15, 2.04); FEV1 OR = 2.48 (1.16, 5.30)] and was elevated in individuals with more severe SGRQ limitations [DLCO QR = 1.13 (0.94, 1.36); FEV1 QR = 1.27 (0.98, 1.64)]. HIV did not modify any associations examined. Age modified the DLCO and any respiratory limitation (SGRQ symptom score) association for every 10 mL CO/min/mmHg decrease in DLCO [age 30 OR = 1.03 (0.51, 2.08); age 50 OR = 1.85 (1.27, 3.85); and age 70 OR = 3.45 (2.00, 5.88)]. Similarly, age modified the DLCO and any respiratory limitation (SGRQ total score) association. FEV1 associations with SGRQ and HRQoL scores were similar across all ages. Impaired pulmonary function was associated with lower HRQoL and greater respiratory impairments. Future studies can determine if interventions aimed at preserving pulmonary function are effective in improving HRQoL and respiratory health among aging men with and without HIV.
Collapse
Affiliation(s)
- Mona Abdo
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ken M. Kunisaki
- Pulmonary Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Alison Morris
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Valentina Stosor
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dong Chang
- Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomed Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance, California, USA
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kristina Crothers
- Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Healthcare System, University of Washington, Seattle, Washington, USA
| | - Madiha Abdel-Maksoud
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kristine M. Erlandson
- Division of Infectious Disease, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Samantha MaWhinney
- Department of Biostatistics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
2
|
Byanova KL, Abelman R, North CM, Christenson SA, Huang L. COPD in People with HIV: Epidemiology, Pathogenesis, Management, and Prevention Strategies. Int J Chron Obstruct Pulmon Dis 2023; 18:2795-2817. [PMID: 38050482 PMCID: PMC10693779 DOI: 10.2147/copd.s388142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by airflow limitation and persistent respiratory symptoms. People with HIV (PWH) are particularly vulnerable to COPD development; PWH have demonstrated both higher rates of COPD and an earlier and more rapid decline in lung function than their seronegative counterparts, even after accounting for differences in cigarette smoking. Factors contributing to this HIV-associated difference include chronic immune activation and inflammation, accelerated aging, a predilection for pulmonary infections, alterations in the lung microbiome, and the interplay between HIV and inhalational toxins. In this review, we discuss what is known about the epidemiology and pathobiology of COPD among PWH and outline screening, diagnostic, prevention, and treatment strategies.
Collapse
Affiliation(s)
- Katerina L Byanova
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rebecca Abelman
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Crystal M North
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Stephanie A Christenson
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laurence Huang
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
3
|
Azezew MT, Gobena T, Mengstie MA, Mulat E. Pulmonary function tests and their associated factors in people living with HIV at Jimma medical center; Ethiopia: a comparative cross-sectional study. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1178304. [PMID: 37901155 PMCID: PMC10611469 DOI: 10.3389/frph.2023.1178304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/21/2023] [Indexed: 10/31/2023] Open
Abstract
Background People living with HIV (PLHIV) have a greater risk of developing respiratory disorders. The problems are linked to poor socio-economic status, high viral load, low CD4 counts, and antiretroviral therapy. Despite the high prevalence of respiratory disorders, the association between HIV infection and pulmonary function status, as well as the associated factors, is not well established in resource-limited countries. Methods A comparative cross-sectional study was conducted from September 24 to October 15 2020 at Jimma Medical Center among people living with HIV who were arranged into an age-sex-matched comparison group. Data were collected using a pretested structured questionnaire administered via face-to-face interviews. The collected data included socio-demographic, respiratory, HIV infection, and substance use variables. Pulmonary function tests were conducted using an SP10 spirometer. The collected data were entered and analyzed using SPSS version 26. Independent t-test and multiple linear regressions were carried out to identify factors associated with the pulmonary function status of the study participants. Results A total of 96 PLHIV and 96 matched control individuals participated in the study. The mean of pulmonary function test parameters among the PLHIV respondents was FVC (l) (67.35 ± 19.12, p0.003), FEV1s (l) (61.76 ± 16.04, p0.001), and PEFR (50.14 ± 23.32, p0.001), with a significant lowering in the study group. Female sex, respiratory symptoms, duration of HIV, duration of treatment, and khat chewing were associated with lowered FEV1s (l) (p < 0.05) in HIV-positive respondents. Conclusion PLHIV had significantly lower mean lung function parameters than HIV-uninfected participants. As a result, health providers should screen HIV-positive patients with respiratory symptoms, prolonged duration of HIV infection, prolonged treatment, and khat chewing for non-infectious lung disorders while treating them.
Collapse
Affiliation(s)
- Muluken Teshome Azezew
- Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Teshome Gobena
- Department of Biomedical Sciences, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Elias Mulat
- Department of Biomedical Sciences, College of Health Sciences, Jimma University, Jimma, Ethiopia
| |
Collapse
|
4
|
Konstantinidis I, Crothers K, Kunisaki KM, Drummond MB, Benfield T, Zar HJ, Huang L, Morris A. HIV-associated lung disease. Nat Rev Dis Primers 2023; 9:39. [PMID: 37500684 PMCID: PMC11146142 DOI: 10.1038/s41572-023-00450-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/29/2023]
Abstract
Lung disease encompasses acute, infectious processes and chronic, non-infectious processes such as chronic obstructive pulmonary disease, asthma and lung cancer. People living with HIV are at increased risk of both acute and chronic lung diseases. Although the use of effective antiretroviral therapy has diminished the burden of infectious lung disease, people living with HIV experience growing morbidity and mortality from chronic lung diseases. A key risk factor for HIV-associated lung disease is cigarette smoking, which is more prevalent in people living with HIV than in uninfected people. Other risk factors include older age, history of bacterial pneumonia, Pneumocystis pneumonia, pulmonary tuberculosis and immunosuppression. Mechanistic investigations support roles for aberrant innate and adaptive immunity, local and systemic inflammation, oxidative stress, altered lung and gut microbiota, and environmental exposures such as biomass fuel burning in the development of HIV-associated lung disease. Assessment, prevention and treatment strategies are largely extrapolated from data from HIV-uninfected people. Smoking cessation is essential. Data on the long-term consequences of HIV-associated lung disease are limited. Efforts to continue quantifying the effects of HIV infection on the lung, especially in low-income and middle-income countries, are essential to advance our knowledge and optimize respiratory care in people living with HIV.
Collapse
Affiliation(s)
- Ioannis Konstantinidis
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kristina Crothers
- Veterans Affairs Puget Sound Healthcare System and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ken M Kunisaki
- Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - M Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Heather J Zar
- Department of Paediatrics & Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Laurence Huang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Alison Morris
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
5
|
Abdo M, Kunisaki KM, Morris A, Stosor V, Chang D, D'Souza G, Crothers K, Abdel-Maksoud M, DiGuiseppi C, Brown TT, MaWhinney S, Erlandson KM. Pulmonary and physical function limitations in aging men with and without HIV from the Multicenter AIDS Cohort Study (MACS). Ann Epidemiol 2022; 76:50-60. [PMID: 36244514 PMCID: PMC9881119 DOI: 10.1016/j.annepidem.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 09/27/2022] [Accepted: 10/06/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE We examined the associations between pulmonary impairments and physical function and whether age, HIV serostatus, or smoking modified these relationships. METHODS Using Multicenter AIDS Cohort Study data, we examined associations between pulmonary function (diffusing capacity for carbon monoxide [DLCO], one-second forced expiratory volume [FEV1]) and subsequent physical outcomes (gait speed, grip strength, frailty [non-frail, pre-frail, frail]) using mixed models. RESULTS Of 1,048 men, 55% were living with HIV, median age was 57(IQR=48,64) and median cumulative pack-years was 1.2(IQR = 0,18.1); 33% and 13% had impaired DLCO and FEV1(<80% predicted), respectively. Participants with impaired DLCO had 3.5 kg (95%CI: -4.6, -2.4) weaker grip strength, 0.04 m/sec (95%CI: -0.06, -0.02) slower gait speed and 4.44-fold (95%CI: 1.81, 10.93) greater odds of frailty compared to participants with normal DLCO. Participants with impaired FEV1 had 3.1 kg (95%CI: -4.8, -1.4) weaker grip strength, similar gait speed (-0.001 m/sec [95%CI: -0.04, 0.03]) and 5.72-fold (95%CI: 1.90, 17.19) greater odds of frailty compared to participants with normal FEV1. Age, but not smoking or HIV, significantly modified the DLCO effect on gait speed and grip strength. CONCLUSIONS Pulmonary impairment and decreased physical function were associated. Preserving pulmonary function may help preserve physical function in aging men with and without HIV.
Collapse
Affiliation(s)
- Mona Abdo
- Department of Epidemiology, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO
| | - Ken M Kunisaki
- Minneapolis Veterans Affairs Health Care System, Pulmonary Section, Minneapolis, MN; Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Alison Morris
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Valentina Stosor
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dong Chang
- Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomed Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance, California
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kristina Crothers
- Pulmonary and Critical Care Section, Veterans Affairs Puget Sound and University of Washington, Seattle, WA
| | - Madiha Abdel-Maksoud
- Department of Epidemiology, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD
| | - Samantha MaWhinney
- Department of Biostatistics, Colorado School of Public Health, Aurora, CO
| | - Kristine M Erlandson
- Division of Infectious Disease, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO.
| |
Collapse
|
6
|
Ddungu A, Semitala FC, Castelnuovo B, Sekaggya-Wiltshire C, Worodria W, Kirenga BJ. Chronic obstructive pulmonary disease prevalence and associated factors in an urban HIV clinic in a low income country. PLoS One 2021; 16:e0256121. [PMID: 34388209 PMCID: PMC8362990 DOI: 10.1371/journal.pone.0256121] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/01/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction In the last decade, survival of people living with HIV (PLHIV) has dramatically increased due wide availability of effective antiretroviral therapy. However, PLHIV remain at a comparatively higher risk of non-communicable comorbidities. We sought to determine the burden of COPD and its associations in an urban tertiary HIV clinic in Uganda. Methods and findings HIV-infected adults attending the Makerere University Joint AIDS program; aged ≥30 years without acute ailments were screened for COPD using study questionnaires and spirometry (post-bronchodilator FEV1/FVC<0.7). We determined its prevalence and association with demographic characteristics, body mass index (BMI) and known risk factors. Of 288 participants enrolled, 177 (61%) were female; 253 (88%) were from urban residences, median age was 45 years (IQR: 39–51), 71(25%) were ‘ever’ smokers, 284(99%) reported biomass fuel use and 72(25%) had a history of tuberculosis. All except 1 participant were on antiretroviral therapy, median current CD4 (cells/mm3) was 558 (IQR 402–753) and 275(96%) were virologically suppressed. Nearly half (130/288, 45%) had recurrent respiratory symptoms. The prevalence of COPD was 3.1% (9/288) [95% CI: 1.63–5.92]. COPD was associated with: previous tuberculosis, (adjusted odds ratio (AOR): 6.36, [95% CI 1.64–35.84], P = 0.036), self-reported chronic shortness of breath (AOR: 9.06, [95% CI 1.34–61.10], P = 0.024) and a BMI <21 Kg/m2 (AOR: 10.42 [95% CI: 1.61–100.00], P = 0.013). Conclusion In this HIV population, COPD prevalence was low and was associated with previous tuberculosis, self-reported chronic shortness of breath and BMI <21 Kg/m2.
Collapse
Affiliation(s)
- Ahmed Ddungu
- Infectious Diseases Institute, Makerere University, Kamplala, Uganda
- Makerere University Lung Institute, Kamplala, Uganda
- * E-mail: ,
| | - Fred C. Semitala
- Makerere University College of Health Sciences, Kamplala, Uganda
- Makerere University Joint AIDS program, Kamplala, Uganda
- Mulago National Referral Hospital, Kamplala, Uganda
| | | | - Christine Sekaggya-Wiltshire
- Infectious Diseases Institute, Makerere University, Kamplala, Uganda
- Mulago National Referral Hospital, Kamplala, Uganda
| | - William Worodria
- Makerere University Lung Institute, Kamplala, Uganda
- Makerere University College of Health Sciences, Kamplala, Uganda
- Mulago National Referral Hospital, Kamplala, Uganda
| | - Bruce J. Kirenga
- Makerere University Lung Institute, Kamplala, Uganda
- Makerere University College of Health Sciences, Kamplala, Uganda
- Mulago National Referral Hospital, Kamplala, Uganda
| |
Collapse
|
7
|
Grabovac I, Veronese N, Stefanac S, Haider S, Jackson SE, Koyanagi A, Meilinger M, Stubbs B, Firth J, Soysal P, Di Gennaro F, Demurtas J, McDermott DT, Abbs AD, Yang L, Smith L. Human Immunodeficiency Virus Infection and Diverse Physical Health Outcomes: An Umbrella Review of Meta-analyses of Observational Studies. Clin Infect Dis 2021; 70:1809-1815. [PMID: 31401650 PMCID: PMC7156772 DOI: 10.1093/cid/ciz539] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/19/2019] [Indexed: 12/12/2022] Open
Abstract
Background Our aim was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies and physical health outcomes associated with human immunodeficiency virus (HIV) but not acquired immunodeficiency syndrome. Methods We performed an umbrella review of observational studies. Evidence was graded as convincing, highly suggestive, suggestive, weak, or nonsignificant. Results From 3413 studies returned, 20 were included, covering 55 health outcomes. Median number of participants was 18 743 (range 403–225 000 000). Overall, 45 (81.8%) of the 55 unique outcomes reported nominally significant summary results (P < .05). Only 5 outcomes (9.0%; higher likelihood of presence of breathlessness, higher chronic obstructive pulmonary disease [COPD] prevalence, maternal sepsis, higher risk of anemia, and higher risk of all fractures among people living with HIV [PLWHIV]) showed suggestive evidence, with P values < 10–3; only 3 (5.5%; higher prevalence of cough in cross-sectional studies, higher incidence of pregnancy-related mortality, and higher incidence of ischemic heart disease among PLWHIV in cohort studies) outcomes showed stronger evidence using a stringent P value (<10–6). None of the unique outcomes presented convincing evidence (Class I), yet 3 outcomes presented highly suggestive evidence, 5 outcomes presented suggestive evidence, and 37 outcomes presented weak evidence. Conclusions Results show highly suggestive and suggestive evidence for HIV and the presence of a cough, COPD, ischemic heart disease, pregnancy-related mortality, maternal sepsis, and bone fractures. Public health policies should reflect and accommodate these changes, especially in light of the increases in the life expectancy and the incidence of comorbidities in this population.
Collapse
Affiliation(s)
- Igor Grabovac
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Austria
| | - Nicola Veronese
- Neuroscience Institute, Aging Branch, National Research Council, Padua, Italy
| | - Sinisa Stefanac
- Institute of Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria
| | - Sandra Haider
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Austria
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, United Kingdom
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Centro de Investigación Biomédica en Red de Salud Mental, Spain
| | - Michael Meilinger
- 2nd Department of Respiratory and Critical Care, Otto Wagner Hospital, Vienna, Austria
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Joseph Firth
- National Institute of Complementary Medicine Health Research Institute, Western Sydney University, Westmead, Australia
| | - Pinar Soysal
- Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
| | | | - Jacopo Demurtas
- Primary Care Department, Azienda Usl Toscana Sud Est, Grosseto, Italy
| | - Daragh T McDermott
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom
| | - Adam D Abbs
- Pennine Acute Hospitals, NHS Trust, United Kingdom
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Holy Cross Centre, Canada.,Preventive Oncology & Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, United Kingdom
| |
Collapse
|
8
|
Byanova KL, Kunisaki KM, Vasquez J, Huang L. Chronic obstructive pulmonary disease in HIV. Expert Rev Respir Med 2021; 15:71-87. [PMID: 33167728 PMCID: PMC7856058 DOI: 10.1080/17476348.2021.1848556] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023]
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is more prevalent in people with HIV (PWH) than in the general population and leads to an increased burden of morbidity and mortality in this population. The mechanisms behind COPD development and progression in PWH are not fully elucidated, and there are no PWH-specific guidelines for COPD management. Areas covered: The goal of this broad narrative review is to review the epidemiology of COPD in PWH globally, highlight proposed pathways contributing to increased COPD prevalence and progression in PWH, discuss structural and functional changes in the lungs in this population, assesses the excess mortality and comorbidities in PWH with COPD, and address management practices for this unique population. Expert opinion: Understanding how a chronic viral infection leads to COPD, independent of cigarette smoking, is of critical scientific importance. Further research should focus on the pathophysiology of the interaction between HIV and COPD, and determine the role of disease-modifying risk factors such as opportunistic pneumonia and air pollution, as well as generate data from randomized clinical trials on the safety and efficacy of specific therapies for this vulnerable patient population.
Collapse
Affiliation(s)
- Katerina L Byanova
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ken M. Kunisaki
- Section of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Joshua Vasquez
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laurence Huang
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- HIV, Infectious Diseases, and Global Medicine Division, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
9
|
SeyedAlinaghi S, Ghadimi M, Hajiabdolbaghi M, Rasoolinejad M, Abbasian L, Nezhad MH, Manshadi SD, Ghadimi F, Ahmadinejad Z. Prevalence of COVID-19-like Symptoms among People Living with HIV, and Using Antiretroviral Therapy for Prevention and Treatment. Curr HIV Res 2020; 18:373-380. [PMID: 32652912 DOI: 10.2174/1570162x18666200712175535] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND COVID-19 has spread globally with remarkable speed, and currently, there is limited data available exploring any aspect of the intersection between HIV and SARSCoV- 2 co-infection. OBJECTIVE To estimate the prevalence of clinical symptoms associated with COVID-19 among people living with HIV (PLWH) in Tehran, Iran. DESIGN Cross-sectional study. METHODS A total of 200 PLWH were recruited through the positive club via sampling, and completed the symptom-based questionnaire for COVID-19, which was delivered by trained peers. RESULTS Of 200 participants, respiratory symptoms, including cough, sputum, and shortness of breath, were the most prevalent among participants, but only one person developed symptoms collectively suggested COVID-19 and sought treatments. CONCLUSION It appears that existing infection with HIV or receiving antiretroviral treatment (ART) might reduce the susceptibility to the infection with SARS-CoV-2 or decrease the severity of the infection acquired. Further research is needed to understand causal mechanisms.
Collapse
Affiliation(s)
- SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of
Medical Sciences, Tehran, Iran
| | - Maryam Ghadimi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins
University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA
| | - Mahboubeh Hajiabdolbaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of
Medical Sciences, Tehran, Iran
| | - Mehrnaz Rasoolinejad
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of
Medical Sciences, Tehran, Iran
| | - Ladan Abbasian
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of
Medical Sciences, Tehran, Iran
| | - Malihe Hassan Nezhad
- Department of Infectious Diseases, Tehran University of Medical Sciences, Tehran, Iran
| | - SeyedAli Dehghan Manshadi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of
Medical Sciences, Tehran, Iran
| | - Fatemeh Ghadimi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of
Medical Sciences, Tehran, Iran
| | - Zahra Ahmadinejad
- Liver Transplantation Research Center, Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Sabin CA, Kunisaki KM, Bagkeris E, Post FA, Sachikonye M, Boffito M, Anderson J, Mallon P, Williams I, Vera JH, Johnson M, Babalis D, Winston A. Respiratory symptoms and chronic bronchitis in people with and without HIV infection. HIV Med 2020; 22:11-21. [PMID: 32892488 DOI: 10.1111/hiv.12955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/29/2020] [Accepted: 08/05/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES High rates of respiratory symptoms and chronic bronchitis (CB) are reported in people with HIV infection (PWH). We investigated the prevalence of respiratory symptoms and CB in PWH and HIV-negative people in the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) study. METHODS Assessment of respiratory symptoms and CB was undertaken using the modified form of the St. George's Respiratory Questionnaire for chronic obstructive pulmonary disease (COPD). Univariate (χ2 tests, Mann-Whitney U tests and Spearman's rank correlation) and multivariable (linear and logistic regression) analyses were performed to consider associations of respiratory symptoms with demographic, lifestyle and HIV-related parameters, and with depressive symptoms and quality of life. RESULTS Among the 619 participants, respiratory Symptom scores were higher in older and younger PWH compared to older HIV-negative people, with median (interquartile range) scores of 17.7 (6.2, 39.5), 17.5 (0.9, 30.0) and 9.0 (0.9, 17.5), respectively (P = 0.0001); these differences remained significant after confounder adjustment. Sixty-three participants (10.2%) met the criteria for CB [44 (14.0%) older PWH, 14 (9.2%) younger PWH, and five (3.3%) older HIV-negative people; P = 0.002], with these differences also remaining after adjustment for confounding variables, particularly smoking status [older vs. younger PWH: odds ratio (OR) 4.48 (95% confidence interval (CI) 1.64, 12.30); P = 0.004; older PWH vs. HIV-negative people: OR 4.53 (95% CI 1.12, 18.28); P = 0.03]. Respiratory symptoms and CB were both associated with greater depressive symptom scores and poorer quality of life. No strong associations were reported between CB and immune function, HIV RNA or previous diagnosis of any AIDS event. CONCLUSIONS Respiratory symptoms and CB are more common in PWH than in demographically and lifestyle-similar HIV-negative people and are associated with poorer mental health and quality of life.
Collapse
Affiliation(s)
- C A Sabin
- Institute for Global Health, UCL, London, UK
| | - K M Kunisaki
- Minneapolis Veterans Affairs Health Care System, and University of Minnesota, Minneapolis, MN, USA
| | - E Bagkeris
- Institute for Global Health, UCL, London, UK
| | - F A Post
- Caldecot Centre, King's College Hospital, London, UK
| | - M Sachikonye
- UK Community Advisory Board (UK-CAB), London, UK
| | - M Boffito
- St. Stephen's Centre, Chelsea and Westminster Hospital, London, UK
| | - J Anderson
- Homerton University Hospital, London, UK
| | - Pwg Mallon
- HIV Molecular Research Group, School of Medicine, University College Dublin, Dublin, Ireland
| | - I Williams
- Institute for Global Health, UCL, London, UK
| | - J H Vera
- Elton John Centre, Brighton and Sussex University Hospital, Brighton, UK.,Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - M Johnson
- Ian Charleson Day Centre, Royal Free NHS Trust, London, UK
| | - D Babalis
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - A Winston
- Department of Infectious Disease, Imperial College London, London, UK
| |
Collapse
|
11
|
Abstract
OBJECTIVES Initial studies suggest HIV-positive persons may be at increased risk for chronic lung diseases such as chronic obstructive pulmonary disease, but have commonly relied on single-center designs, lacked HIV-negative controls, or assessed lung function with only spirometry. We tested differences in spirometry and single-breath diffusing capacity for carbon monoxide (DLCO) in persons with and without HIV. DESIGN Cross-sectional, observational study. METHODS Participants were enrolled from the Multicenter AIDS Cohort Study, a longitudinal cohort study of men who have sex with men (both HIV-positive and HIV-negative) at four sites in the United States. Standardized spirometry and DLCO testing were performed in all eligible, consenting participants at routine study visits. We tested associations between HIV status and spirometry and DLCO results, using linear and logistic regression. RESULTS Among 1067 men, median age was 57 years, prevalence of current marijuana (30%), and cigarette (24%) use was high, and another 45% were former cigarette smokers. Median forced expiratory volume in 1 s was 97% of predicted normal and DLCO was 85% of predicted normal. HIV-positive persons demonstrated no statistical difference in forced expiratory volume in 1 s compared with HIV-negative persons, but had worse DLCO (adjusted difference -2.6% of predicted; 95% confidence interval: -4.7 to -0.6%) and a higher risk of DLCO impairment (odds ratio for DLCO < 60% of predicted 2.97; 95% confidence interval: 1.36-6.47). Lower DLCO was associated with lower nadir CD4 cell counts. CONCLUSION HIV-positive men are at increased risk of abnormal gas exchange, indicated by low DLCO, compared with men without HIV.
Collapse
|
12
|
Brown J, Pickett E, Smith C, Sachikonye M, Brooks L, Mahungu T, Lowe DM, Madge S, Youle M, Johnson M, Hurst JR, McHugh TD, Abubakar I, Lipman M. The effect of HIV status on the frequency and severity of acute respiratory illness. PLoS One 2020; 15:e0232977. [PMID: 32469981 PMCID: PMC7259631 DOI: 10.1371/journal.pone.0232977] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/24/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Antiretroviral therapy has improved the health of people living with HIV (PLW-HIV), though less is known about how this impacts on acute respiratory illness. These illnesses are a common cause of ill health in the general population and any increase in their frequency or severity in PLW-HIV might have significant implications for health-related quality of life and the development of chronic respiratory disease. Methods In a prospective observational cohort study following PLW-HIV and HIV negative participants for 12 months with weekly documentation of any acute respiratory illness, we compared the frequency, severity and healthcare use associated with acute respiratory illnesses to determine whether PLW-HIV continue to have a greater frequency or severity of such illnesses despite antiretroviral therapy. Results We followed-up 136 HIV positive and 73 HIV negative participants for 12 months with weekly documentation of any new respiratory symptoms. We found that HIV status did not affect the frequency of acute respiratory illness: unadjusted incidence rates per person year of follow-up were 2.08 illnesses (95% CI 1.81–2.38) and 2.30 illnesses (1.94–2.70) in HIV positive and negative participants respectively, IRR 0.87 (0.70–1.07) p = 0.18. However, when acute respiratory illnesses occurred, PLW-HIV reported more severe symptoms (relative fold-change in symptom score 1.61 (1.28–2.02), p <0.001) and were more likely to seek healthcare advice (42% vs 18% of illnesses, odds ratio 3.32 (1.48–7.39), p = 0.003). After adjustment for differences in baseline characteristics, PLW-HIV still had higher symptom scores when unwell. Conclusions HIV suppression with antiretroviral therapy reduces the frequency of acute respiratory illness to background levels, however when these occur, they are associated with more severe self-reported symptoms and greater healthcare utilisation. Exploration of the reasons for this greater severity of acute respiratory illness may allow targeted interventions to improve the health of people living with HIV. Trial registration ISRCTN registry (ISRCTN38386321).
Collapse
Affiliation(s)
- James Brown
- Division of Medicine, UCL Respiratory, University College London, London, England, United Kingdom
- Royal Free London NHS Foundation Trust, London, England, United Kingdom
- * E-mail:
| | - Elisha Pickett
- Royal Free London NHS Foundation Trust, London, England, United Kingdom
| | - Colette Smith
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, England, United Kingdom
| | - Memory Sachikonye
- UK-CAB, HIV Treatment Advocates Network, London, England, United Kingdom
| | - Lucy Brooks
- The Keats Group Practice, London, England, United Kingdom
| | - Tabitha Mahungu
- Royal Free London NHS Foundation Trust, London, England, United Kingdom
| | - David M. Lowe
- Royal Free London NHS Foundation Trust, London, England, United Kingdom
- Institute of Immunity and Transplantation, University College London, London, England, United Kingdom
| | - Sara Madge
- Royal Free London NHS Foundation Trust, London, England, United Kingdom
| | - Mike Youle
- Royal Free London NHS Foundation Trust, London, England, United Kingdom
| | - Margaret Johnson
- Royal Free London NHS Foundation Trust, London, England, United Kingdom
| | - John R. Hurst
- Division of Medicine, UCL Respiratory, University College London, London, England, United Kingdom
| | - Timothy D. McHugh
- Division of Infection & Immunity, UCL Centre for Clinical Microbiology, University College London, London, England, United Kingdom
| | - Ibrahim Abubakar
- Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, University College London, London, England, United Kingdom
| | - Marc Lipman
- Division of Medicine, UCL Respiratory, University College London, London, England, United Kingdom
- Royal Free London NHS Foundation Trust, London, England, United Kingdom
| |
Collapse
|
13
|
Brown J, Kyriacou C, Pickett E, Edwards K, Joshi H, Stewart N, Melville A, Johnson M, Flint J, Bartley A, Rodger A, Lipman M. Systematic identification and referral of smokers attending HIV ambulatory care highlights the failure of current service provision in an at-risk population. BMJ Open Respir Res 2019; 6:e000395. [PMID: 31673360 PMCID: PMC6797406 DOI: 10.1136/bmjresp-2018-000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction People living with HIV (PLWH) are more likely to smoke than the general population and are at greater risk of smoking-related illness. Healthcare services need to address this burden of preventable disease. Methods We evaluated the impact of a brief intervention that asked service users about smoking when they attended for ambulatory HIV care in London, UK, and offered referral to smoking cessation. Results Overall, 1548 HIV-positive individuals were asked about their smoking status over a 12-month period. Of this group, 385 (25%) reported that they were current smokers, 372 (97%) were offered referral to smoking cessation services and 154 (40%) accepted this. We established an outcome of referral for 114 (74%) individuals. A total of 36 (10% of smokers) attended stop smoking clinics and 16 (4%) individuals were recorded as having quit smoking. Discussion The simple intervention of asking PLWH about tobacco smoking and offering referral to smoking cessation services rapidly identified current smokers, 40% of whom accepted referral to smoking cessation services. This highlights the importance of promoting behaviour and lifestyle changes with every contact with health services. However, a large proportion of those referred were either not seen in local services or the outcome of referral could not be ascertained. If the risk of smoking-related morbidity among PLWH is to be reduced, more sustainable referral pathways and ways of improving uptake of smoking cessation services must be developed.
Collapse
Affiliation(s)
- James Brown
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | | | - Elisha Pickett
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Kelly Edwards
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Hemal Joshi
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Nafeesah Stewart
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Andrew Melville
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Margaret Johnson
- Respiratory and HIV Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Jan Flint
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Angela Bartley
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Alison Rodger
- Institute for Global Health, University College London Medical School, London, UK
| | - Marc Lipman
- UCL Respiratory, University College London, London, UK
| |
Collapse
|
14
|
Kummerow M, Shaddock EJ, Klipstein-Grobusch K, Barth RB, Grobbee DE, Venter FDF, Feldman C, Vos A. Unexpected low frequency of respiratory symptoms in an HIV-positive urban sub-Saharan population compared to an HIV-negative control group. South Afr J HIV Med 2019; 20:1010. [PMID: 31616576 PMCID: PMC6779989 DOI: 10.4102/sajhivmed.v20i1.1010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023] Open
Abstract
Background Chronic respiratory illnesses and respiratory infections are common in HIV-positive populations. It seems reasonable that HIV-positive people experience more respiratory symptoms, such as coughing and breathlessness, than those who are HIV-negative. Objectives This study aims to determine the frequency of respiratory symptoms in an urban African HIV-positive population. Method A cross-sectional study was conducted in Johannesburg, South Africa, in 2016–2017. Four groups of participants were included: HIV-positive participants (1) not yet on antiretroviral therapy (ART), (2) on first-line ART, (3) on second-line ART and (4) age- and sex-matched HIV-negative controls. Data were collected on socio-demographics, respiratory risk factors and respiratory symptoms. A logistic regression analysis was performed to determine if respiratory symptoms differed between groups and to identify determinants associated with symptoms. Results Overall, 547 participants were included, of whom 62% were women, with a median age of 37 years. Of these patients, 63% (347) were HIV-positive, 26% were ART-naïve, 24% were on first-line ART and 50% were on second-line ART. Cough and/or productive cough was reported by 27 (5%), wheezing by 9 (2%) and breathlessness by 118 (22%) of the participants. The frequency of these symptoms did not differ by HIV status after adjustment for age and sex. Breathlessness was associated with age, female sex, obesity, a history of respiratory infection and a history of airway hyper-reactivity. Conclusion The frequency of respiratory symptoms was low in our study population except for breathlessness. HIV-positive participants, whether or not on ART, did not experience more symptoms than HIV-negative participants.
Collapse
Affiliation(s)
- Maren Kummerow
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Erica J Shaddock
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Roos B Barth
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Francois D F Venter
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University the of Witwatersrand, Johannesburg, South Africa
| | - Alinda Vos
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
15
|
Roos R, Myezwa H, van Aswegen H. Factors associated with physical function capacity in an urban cohort of people living with the human immunodeficiency virus in South Africa. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2019; 75:1323. [PMID: 31616799 PMCID: PMC6780000 DOI: 10.4102/sajp.v75i1.1323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 07/05/2019] [Indexed: 11/24/2022] Open
Abstract
Background Effective disease management for people living with human immunodeficiency virus (PLWH) includes the encouragement of physical activity. Physical function capacity in PLWH may be influenced by a variety of factors. Objectives This study describes the physical function capacity as assessed with the 6-minute walk test (6MWT) of an urban cohort of PLWH and determined whether a history of pulmonary tuberculosis (PTB), anthropometric measures, age and gender predicted distance walked. Method Secondary data collected from 84 PLWH on antiretroviral therapy were analysed. Information included 6MWT distance, anthropometric measurements and demographic profiles. Descriptive and inferential statistics were undertaken on the data. A regression analysis determined predictive factors for 6MWT distance achieved. Significance was set at a p-value of ≤ 0.05. Results The study consisted of 66 (78.6%) women and 18 (21.4%) men with a mean age of 39.1 (± 9.2) years. The 6MWT distance of the cohort was 544.3 (± 64.4) m with men walking further (602.8 [± 58.6] m) than women (528.3 [± 56.4] m); however, women experienced greater effort. The majority of the sample did not report a history of PTB (n = 67; 79.8%). Age, gender and anthropometric measures were associated with 6MWT distance, but of low to moderate strength. The regression equation generated included age and gender. This model was statistically significant (p < 0.00) and accounted for 34% of the total variance observed. Conclusion Age and gender were predictive factors of physical function capacity and women experienced greater effort. Clinical implications This study provides information on the physical function capacity of PLWH and a suggested 6MWT reference equation for PLWH in South Africa.
Collapse
Affiliation(s)
- Ronel Roos
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Hellen Myezwa
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Heleen van Aswegen
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
16
|
Aliyu YA, Botai JO. An Exposure Appraisal of Outdoor Air Pollution on the Respiratory Well-being of a Developing City Population. J Epidemiol Glob Health 2019; 8:91-100. [PMID: 30859794 PMCID: PMC7325812 DOI: 10.2991/j.jegh.2018.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/05/2018] [Indexed: 11/09/2022] Open
Abstract
Zaria is the educational hub of northern Nigeria. It is a developing city with a pollution level high enough to be ranked amongst the World Health Organization’s (WHO) most polluted cities. The study appraised the influence of outdoor air pollution on the respiratory well-being of a population in a limited resource environment. With the approved ethics, the techniques utilized were: portable pollutant monitors, respiratory health records, WHO AirQ+ software, and the American Thoracic Society (ATS) questionnaire. They were utilized to acquire day-time weighted outdoor pollution levels, health respiratory cases, assumed baseline incidence (BI), and exposure respiratory symptoms among selected study participants respectively. The study revealed an average respiratory illness incidence rate of 607 per 100,000 cases. Findings showed that an average of 2648 cases could have been avoided if the theoretical WHO threshold limit for the particulate matter with diameter of <2.5/10 micron (PM2.5/PM10) were adhered to. Using the questionnaire survey, phlegm was identified as the predominant respiratory symptom. A regression analysis showed that the criteria pollutant PM2.5, was the most predominant cause of respiratory symptoms among interviewed respondents. The study logistics revealed that outdoor pollution is significantly associated with respiratory well-being of the study population in Zaria, Nigeria.
Collapse
Affiliation(s)
- Yahaya A Aliyu
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa.,Department of Geomatics, Ahmadu Bello University, Zaria, Nigeria
| | - Joel O Botai
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa.,South African Weather Service, Erasmusrand, Pretoria, South Africa
| |
Collapse
|
17
|
Abstract
: Improved survival among HIV-1-infected individuals with the advent of antiretroviral therapy has clearly led to a greater prevalence of noninfectious complications. One of the most devastating sequelae in these individuals is the development of pulmonary arterial hypertension (PAH). Various epidemiological studies suggest worse survival of HIV-PAH patients when compared with other forms of PAH. Given that only a subset and not all HIV-infected individuals develop HIV-PAH, it is suggested that an additional second-hit of genetic or environmental trigger is needed for the development of PAH. In this context, it has been well documented that HIV patients who abuse illicit drugs such as stimulants, opioids, and the like, are more susceptible to develop PAH. In this review, we highlight the studies that support the significance of a double hit of HIV and drug abuse in the incidence of PAH and focus on the research that has been undertaken to unravel the pathobiology and vascular remodeling mechanisms underlying the deleterious synergy between HIV infection and drugs of abuse in orchestrating the development of PAH.
Collapse
|
18
|
Xu S, Tsai A, Sze MA, Vucic EA, Shaipanich T, Harris M, Guillemi S, Yang J, Sinha S, Nislow C, Montaner J, Lam W, Lam S, Sin DD, Paul Man SF, Leung JM. Decreased microbiome diversity in the HIV small airway epithelium. Respir Res 2018; 19:140. [PMID: 30053882 PMCID: PMC6062954 DOI: 10.1186/s12931-018-0835-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/25/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Persons living with human immunodeficiency virus (PLWH) face an increased burden of chronic obstructive pulmonary disease (COPD). Repeated pulmonary infections, antibiotic exposures, and immunosuppression may contribute to an altered small airway epithelium (SAE) microbiome. METHODS SAE cells were collected from 28 PLWH and 48 HIV- controls through bronchoscopic cytologic brushings. DNA extracted from SAE cells was subjected to 16S rRNA amplification and sequencing. Comparisons of alpha and beta diversity between HIV+ and HIV- groups were performed and key operational taxonomic units (OTUs) distinguishing the two groups were identified using the Boruta feature selection after Random Forest Analysis. RESULTS PLWH demonstrated significantly reduced Shannon diversity compared with HIV- volunteers (1.82 ± 0.10 vs. 2.20 ± 0.073, p = 0.0024). This was primarily driven by a reduction in bacterial richness (23.29 ± 2.75 for PLWH and 46.04 ± 3.716 for HIV-, p < 0.0001). Phyla distribution was significantly altered among PLWH, with an increase in relative abundance of Proteobacteria (p = 0.0003) and a decrease in Bacteroidetes (p = 0.0068) and Firmicutes (p = 0.0002). Six discriminative OTUs were found to distinguish PLWH from HIV- volunteers, aligning to Veillonellaceae, Fusobacterium, Verrucomicrobiaceae, Prevotella, Veillonella, and Campylobacter. CONCLUSIONS Compared to HIV- controls, PLWH's SAE microbiome is marked by reduced bacterial diversity and richness with significant differences in community composition.
Collapse
Affiliation(s)
- Stella Xu
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Amy Tsai
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marc A Sze
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Emily A Vucic
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Tawimas Shaipanich
- Division of Respiratory Medicine, St. Paul's Hospital, Vancouver, BC, Canada
| | - Marianne Harris
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Silvia Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Julia Yang
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Sunita Sinha
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Corey Nislow
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Wan Lam
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Stephen Lam
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
- Division of Respiratory Medicine, St. Paul's Hospital, Vancouver, BC, Canada
| | - S F Paul Man
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
- Division of Respiratory Medicine, St. Paul's Hospital, Vancouver, BC, Canada
| | - Janice M Leung
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.
- Division of Respiratory Medicine, St. Paul's Hospital, Vancouver, BC, Canada.
- Centre for Heart Lung Innovation, St. Paul's Hospital, Room 166-1081 Burrard Street, Vancouver, V6Z 1Y6, Canada.
| |
Collapse
|
19
|
Nliwasa M, MacPherson P, Gupta‐Wright A, Mwapasa M, Horton K, Odland JØ, Flach C, Corbett EL. High HIV and active tuberculosis prevalence and increased mortality risk in adults with symptoms of TB: a systematic review and meta-analyses. J Int AIDS Soc 2018; 21:e25162. [PMID: 30063287 PMCID: PMC6067081 DOI: 10.1002/jia2.25162] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/21/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION HIV and tuberculosis (TB) remain leading causes of preventable death in low- and middle-income countries (LMICs). The World Health Organization (WHO) recommends HIV testing for all individuals with TB symptoms, but implementation has been suboptimal. We conducted a systematic literature review and meta-analyses to estimate HIV and TB prevalence, and short-term (two to six months) mortality, among adults with TB symptoms at community- and facility level. METHODS We searched Embase, Global Health and MEDLINE databases, and reviewed conference abstracts for studies reporting simultaneous HIV and TB screening of adults in LMICs published between January 2003 and December 2017. Meta-analyses were performed to estimate prevalence of HIV, undiagnosed TB and mortality risk at different health system levels. RESULTS Sixty-two studies including 260,792 symptomatic adults were identified, mostly from Africa and Asia. Median HIV prevalence was 19.2% (IQR: 8.3% to 40.4%) at community level, 55.7% (IQR: 20.9% to 71.2%) at primary care level and 80.7% (IQR: 73.8% to 84.6%) at hospital level. Median TB prevalence was 6.9% (IQR: 3.3% to 8.4%) at community, 20.5% (IQR: 11.7% to 46.4%) at primary care and 36.4% (IQR: 22.9% to 40.9%) at hospital level. Median short-term mortality was 22.6% (IQR: 15.6% to 27.7%) among inpatients, 3.1% (IQR: 1.2% to 4.2%) at primary care and 1.6% (95% CI: 0.45 to 4.13, n = 1 study) at community level. CONCLUSIONS Adults with TB symptoms have extremely high prevalence of HIV infection, even when identified through community surveys. TB prevalence and mortality increased substantially at primary care and inpatient level respectively. Strategies to expand symptom-based TB screening combined with HIV and TB testing for all symptomatic individuals should be of the highest priority for both disease programmes in LMICs with generalized HIV epidemics. Interventions to reduce short-term mortality are urgently needed.
Collapse
Affiliation(s)
- Marriott Nliwasa
- Helse Nord Tuberculosis InitiativeDepartment of PathologyCollege of MedicineBlantyreMalawi
- Malawi‐Liverpool‐Welcome Trust Clinical Research ProgrammeBlantyreMalawi
- Clinical Research DepartmentLondon School of Hygiene & Tropical Medicine (LSHTM)LondonUK
| | - Peter MacPherson
- Department of Clinical SciencesLiverpool School of Tropical MedicineLiverpoolUK
| | - Ankur Gupta‐Wright
- Malawi‐Liverpool‐Welcome Trust Clinical Research ProgrammeBlantyreMalawi
- Clinical Research DepartmentLondon School of Hygiene & Tropical Medicine (LSHTM)LondonUK
| | - Mphatso Mwapasa
- Helse Nord Tuberculosis InitiativeDepartment of PathologyCollege of MedicineBlantyreMalawi
| | - Katherine Horton
- Clinical Research DepartmentLondon School of Hygiene & Tropical Medicine (LSHTM)LondonUK
| | - Jon Ø Odland
- Department of Community MedicineFaculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
- School of Public HealthUniversity of PretoriaPretoriaSouth Africa
| | - Clare Flach
- Department of Primary Care & Public Health SciencesKing's College LondonLondonUK
| | - Elizabeth L. Corbett
- Helse Nord Tuberculosis InitiativeDepartment of PathologyCollege of MedicineBlantyreMalawi
- Malawi‐Liverpool‐Welcome Trust Clinical Research ProgrammeBlantyreMalawi
- Clinical Research DepartmentLondon School of Hygiene & Tropical Medicine (LSHTM)LondonUK
| |
Collapse
|
20
|
Abstract
: HIV in the antiretroviral therapy era is characterized by multimorbidity and the frequent occurrence of HIV-associated non-AIDS chronic health conditions. Respiratory symptoms and chronic pulmonary diseases, including chronic obstructive pulmonary disease, asthma, and cardiopulmonary dysfunction, are among the conditions that may present in persons living with HIV. Tobacco smoking, which is disproportionately high among persons living HIV, strongly contributes to the risk of pulmonary disease. Additionally, features associated with and at times unique to HIV, including persistent inflammation, immune cell activation, oxidative stress, and dysbiosis, may also contribute. This review summarizes the available literature regarding epidemiology of and risk factors for respiratory symptoms and chronic pulmonary disease in the current era.
Collapse
|