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Prevalence and Risk Factors of COPD in HIV-Infected Adults with CD4 > 500 Cells/mm³

This study investigates the prevalence of Chronic Obstructive Pulmonary Disease (COPD) among HIV-infected adults with CD4 counts above 500 cells/mm³, based on data from over 1,000 participants across 80 sites in 20 countries. The findings reveal an overall COPD prevalence of 6.8%, influenced predominantly by aging and smoking. The research highlights the significant relationship between COPD risk and demographic variables, emphasizing the need for effective screening and management tools within this population. Smoking cessation initiatives are critical for improving outcomes.

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Prevalence and Risk Factors of COPD in HIV-Infected Adults with CD4 > 500 Cells/mm³

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  1. Chronic obstructive pulmonary disease (COPD)in a large international cohort of HIV-infected adults with CD4+ >500 cells/mm3 Ken Kunisaki, M.D., M.S. Co-authors: Dennis Niewoehner, Gary Collins, Daniel Nixon, Ellen Tedaldi, Christopher Akolo, Cissy Kityo, HartwigKlinker, Alberto La Rosa, John Connett, and the INSIGHT START Study Team

  2. Conflicts of Interest • I have no conflicts of interest to report

  3. COPD: Chronic Obstructive Pulmonary Disease Niewoehner DE. N Engl J Med 2010;362:1407

  4. Global Burden of Disease Study. Lancet 2012;380:2095-2128

  5. HIV Increases COPD Risk • Main COPD risk factor is cigarette smoking • HIV is also a COPD risk factor Kuhlman 1989, Gelman 1999, Diaz 2000, Morris 2000, Crothers 2006, Crothers 2011, Drummond 2011, Drummond 2013, Nakamura 2014 • COPD prevalence in PLWH varies from 3%-23% George 2009, Cui 2010, Gingo 2010, Hirani 2011, Kristoffersen 2012, Drummond 2013, Madeddu 2013, Samperiz 2013, Nakamura 2014 • We aimed to assess COPD prevalence in a large, multi-site, multi-national sample of PLWH.

  6. START Pulmonary Substudy • Strategic Timing of Antiretroviral Treatment (START) Trial • Infected with HIV-1, naïve to ART • CD4 >500 cells/mm3 • Age ≥18 • Not currently pregnant • Pulmonary Substudy • Age ≥25 • No asthma medication use • No contraindications to post-bronchodilator spirometry • Unstable heart disease, surgery within 6 months, respiratory illness within 6 weeks, allergy to albuterol/salbutamol

  7. Methods • Post-bronchodilator spirometry • FEV1 • FVC • FEV1/FVC ratio FEV1/FVC <5th %tile

  8. Enrollment

  9. Demographics

  10. Regional Demographics

  11. COPD Prevalence Overall COPD prevalence 6.8% (95% CI: 5.3% - 8.5%)

  12. COPD Prevalence – Region

  13. COPD by Age & Smoking

  14. Spirometry Regression Analysis • Multivariate linear regression • Lower FEV1/FVC ratio associated with: • Older age (p<0.0001) • Increased smoking pack-years (p<0.0001) • Differed by region (p=0.01)

  15. Conclusions • Successfully enrolled 1,026 adult PLWH (CD4>500, naïve to ART) from 80 sites and 20 countries • COPD: • is not uncommon (6.8%) • appears to relate strongest to smoking and aging • varies by global region

  16. Clinical Implications • Smoking cessation • COPD as PLWH age • Need to familiarize PLWH providers with tools for COPD screening, diagnosis, management

  17. Future Directions • Prospective data • Kristoffersen 2012: n=63 (Denmark); 9.5% COPD prevalence at baseline; 19.0% at 4.4 year follow-up. • ART effect on lung function decline • Conflicting data on ART as COPD risk factor • Randomized allocation will address this

  18. Acknowledgements Thank you to each of the 1,026 substudy participants • 80 sites around the world • University of Minnesota (USA) • Gary Collins, Mollie Roediger-Poelhman, Carol Miller, John Connett, Dennis Niewoehner • The Kirby Institute (Australia) • Cate Carey, Simone Jacoby, Vida Shahamat, Megan Clewett • Copenhagen HIV Programme (Denmark) • Bitten Aagaard, Mary Pearson, Per Jansson, DaniellaGey • MRC Clinical Trials Unit (UK) • NafisahBraimah, Fleur Hudson, Michelle Gabriel, Nicki Doyle • CPCRA (USA) • Betsy Finley, Adriana Sanchez • Ellen Tedaldi (Temple Univ, USA) • Daniel Nixon (VCU, USA) • Jorgen Vestbo (Manchester Univ, UK) Study funded by R01 HL096453

  19. Multivariate Linear Regression

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