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Respiratory co-morbidities in people with HIV
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Lancet Inf Dis Jan 2016 James Brown, Colette Smith, Margaret Johnson, Marc Lipman, Ibrahim Abubakar
Royal Free London NHS Foundation Trust and UCL
Respiratory, Division of Medicine (JB, ML),
Department of Infection and Population Health (CS,
IA) University College London, London, UK; and Royal
Free London NHS Foundation Trust, London, UK (MJ)
The study by Mikaela Smit and colleagues is a valuable contribution to the understanding of non-communicable diseases in ageing populations with HIV.1However, expansion of the non-communicable diseases studied could increase the ability of the model to accurately predict the future effect of non-communicable disease in this population. The researchers acknowledge the omission of neurocognitive disorders, but respiratory disease also merits attention.
Respiratory diseases are key comorbidities in an ageing population and a leading source of health-care costs in elderly people, with a lifetime risk of about 25% of developing chronic obstructive pulmonary disease (COPD) in high-income countries.2 COPD is more prevalent in those with HIV than in the general population, and seems to be a result of HIV infection plus higher rates of smoking.3
Smit and colleagues exclude respiratory disease from their model on the grounds that the higher rate of obstructive lung disease seen in HIV-positive participants in the AGEhIV cohort was not significant.4 However, obstructive lung disease was present in 30% of this population and was the second most common non-communicable disease recorded after hypertension.
A high incidence of lung disease has been reported in HIV-infected populations elsewhere. For instance, COPD was diagnosed in 8% of participants with HIV in the Multicentre AIDS Cohort study,5 15% in the Women's Interagency Cohort Study,5 and 16% of those in the Veterans Aging Cohort Study,6 all of which were higher than in the HIV-negative participants also investigated in these studies. Because COPD prevalence increases with age,7 this disease will probably become more important in older people with HIV, and its management adds to the complexities of care for these populations, in particular risking drug interactions between antiretroviral medications and oral and inhaled steroids.8 The higher frequency of tobacco smoking reported in many HIV-positive populations (including the ATHENA cohort used by Smit and coworkers) means that smoking-related disorders will be increasingly important.3 Interventions such as smoking cessation are often ignored, but will be of increasing relevance in view of not only the effect they might have on COPD progression, but also on cardiovascular disease and cancers.

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