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High Prevalence and Severity of Pulmonary Emphysema is Associated with Cardiovascular Morbidity
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Reported by Jules Levin
CROI 2013
Giovanni Guaraldi1, Giulia Besutti1, Riccardo Scaglioni1, Antonella Santoro1, Stefano Zona1, Elisa Garlassi1, Guido Ligabue1, Cristina Mussini1, Don Sin2,3, Jonathon Leipsic2,3, and Paul Man2,3
1Modena and Reggio Emilia Univ, Modena, Italy 2 British Columbia Univ, James Hogg Res Ctr, Vancouver, British Columbia, Canada 3 St. Paul`s Hosp, Vancouver, British Columbia, Canada
1. Emphysema and bronchiolitis are extremely common in HIV-infected patients who are treated with ART
- Morphologically diagnosed COPD was present in almost 50%, and emphysema in ~35%, of HIV infected patients who had not a primary respiratory complaint
- This high disease burden may suggest that smoke related lung disease in HIV could be considered among the HIV Associated Non AIDS (HANA) conditions
2. It is possible that the pathogenesis and natural history of "emphysema" and "bronchiolitis" in HIV may be dissimilar to those in non-HIV smoking patients
- With increasing severity of emphysema, a progressive reduction in the FEV1/FVC ratio was noted too. However, even in the group with very severe emphysema (score of >4), the vast majority of subjects had an FEV1/FVC ratio within normal limits (>0.7).
3. CT scanning is extremely helpful for non-invasive morphological phenotyping and detection of early disease in patients with multiple risk factors for lung diseases
4. This study confirm that emphysema and its severity is a powerful, independent risk factor for cardiovascular morbidity
- Emphysema and CVD share common risk factors, they are both associated with a chronic inflammation status
5. There is an urgent need to tackle the enormous burden of lung disease in these patients through better and more comprehensive management of their cigarette and illicit drug addiction, improved education, and additional research on mechanisms responsible for accelerated COPD in this group of patients.
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