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  21st Conference on Retroviruses and
Opportunistic Infections
Boston, MA March 3 - 6, 2014
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One Quarter of HIV+ Smoker Group Has COPD--Risk Lower With Higher CD4s
  CROI 2014, March 3-6, 2014, Boston
Mark Mascolini
One quarter of a heavy-smoking HIV group had chronic obstructive pulmonary disease (COPD) in a 334-person French analysis [1]. Older age made COPD more likely, while a higher current CD4 count cut chances of COPD. Marijuana use, lower body mass index, and prior lung infection tended to boost chances of COPD.
Prior research found a higher risk of COPD in people with HIV than in the general population, partly because of higher smoking prevalence in HIV-positive people but perhaps also because of HIV-related factors [2,3]. To identify COPD risk factors in an older high-risk population, ANRS investigators conducted a cross-sectional study of people enrolled in the prospective CHEST cohort.
The analysis included people at least 40 years old with a 20 or more pack-year smoking history within the past 3 years. (A pack-year equals the number of packs smoked daily times the number of years smoked. So 20 pack-years means smoking 1 pack a day for 20 years or 2 packs a day for 10 years.) Everyone had a nadir CD4 count below 350 and a current CD4 count above 100. The ANRS team excluded pregnant or breastfeeding women and people with active cancer, an AIDS illness, or lung infection within 2 months. They defined COPD by GOLD criteria (http://www.goldcopd.org). All participants had spirometry and plethysmography. (Spirometry measures air volume and flow within the lungs; plethysmography measures how much air the lungs can hold).
Of the 334 study participants, 83 (25%) had COPD. Proportions of women were 16% in the COPD group and 18% in the no-COPD group. Compared with people without COPD, those with COPD had an older median age (52 versus 49), higher median pack-years (34 versus 30), a higher proportion with a marijuana history (42% versus 32%), a higher proportion of injection drug users (34% versus 22%), and a higher proportion with body mass index below 18.5 kg/m(2) (17% versus 8%). Low proportions of people with and without COPD (13% and 8%) had a history of Pneumocystis pneumonia or bacterial pneumonia.
People with COPD had taken antiretrovirals for a median 13 years, compared with 14 years in the no-COPD group. Current median CD4 count was moderately lower in people with than without COPD (500 versus 597), as was nadir median CD4 count (162 versus 182). The same proportion in each group, 88%, had a latest viral load below 50 copies.
Multivariate analysis considering age, gender, CD4 count, viral load, antiretroviral treatment duration, and an array of lung risk factors identified two independent predictors of COPD. Every additional 10 years of age more than doubled the odds of COPD (adjusted odds ratio [aOR] 2.34, 95% confidence interval [CI] 1.48 to 3.70, P < 0.001). And every 100-cell higher current CD4 count lowered the odds 10% (aOR 0.90, 95% CI 0.81 to 0.99, P = 0.039).
This analysis also picked out three factors that tended to boost odds of COPD in associations that fell short of statistical significance: history of marijuana use (aOR 1.69, 95% CI 0.96 to 2.99, P = 0.071), body mass index below 18.5 kg/m(2) (aOR 2.05, 95% CI 0.94 to 4.46, P = 0.071), and history of Pneumocystis or other lung infection (aOR 2.07, 95% CI 0.90 to 4.80, P = 0.089). Gender, smoking pack-years, nadir CD4 count, and current viral load did not affect COPD risk.
The researchers believe the high COPD prevalence in this middle-aged, heavy-smoking group justifies screening and early diagnosis strategies recommended by GOLD, the Global Initiative for Chronic Obstructive Lung Disease (http://www.goldcopd.org). The link between higher CD4 count and lower COPD odds, the investigators argue, add to evidence supporting "early and universal antiretroviral treatment."
1. Makinson A, Hayot M, Eymard-Duvernay S, et al. Factors associated with chronic obstructive pulmonary disease in a high risk-HIV-infected cohort. CROI 2014. Conference on Retroviruses and Opportunistic Infections. March 3-6, 2014. Boston. Abstract 776.
2. Morris A, Alexander T, Radhi S, et al. Airway obstruction is increased in pneumocystis-colonized human immunodeficiency virus-infected outpatients. J Clin Microbiol. 2009;47:3773-3776.
3. Drummond MB, Kirk GD, Astemborski J, et al. Prevalence and risk factors for unrecognized obstructive lung disease among urban drug users. Int J Chron Obstruct Pulmon Dis. 2011;6:89-95.