| |
Non-Smokers Are At Risk for COPD & Marijuana May Add to Risk, Smokers Are At Greater Risk. Lung Cancer in HIV+ is one of the more frequent cancers among men
|
| |
| |
Download the PDF here
This review and the other 2 linked to studies below at the Comorbidities Workshop last month in NUC covers the full scope of COPD in HIV.
Lung disease in HIV: Causes and consequences - (10/16/18)
Previously, we have shown a substantial burden of respiratory symptoms among both HIV-infected and uninfected persons with a history of injecting drugs.
There was no statistically significant relationship in the prevalence of airflow obstruction according to HIV viral load: 24% with HIV viral load >500 copies per milliliter had airflow obstruction compared with 17% with viral load ≤500 copies per milliliter and 16% of HIV-uninfected participants (P = 0.4)......However, DLCO (diffusing capacity) was associated with both recent and nadir CD4 cell count; the relationship seemed more strongly related to recent CD4 cell count (see Table S1, Supplemental Digital Content, http://links.lww.com/QAI/A464). HIV-infected men with a recent CD4 cell count <200 cells per microliter and those with a CD4 between 200 and 349 cells per microliter had a significantly lower DLCO when compared with HIV-infected men with a CD4 cell count ≥350 cells and to HIV-uninfected men (Fig. 2)......In summary, HIV-infected men had a significantly decreased DLCO compared with HIV-uninfected men even after adjusting for smoking and other potential confounders, and despite widespread use of ART. Overall, 30% of HIV-infected men had a DLCO ≤60% of predicted normal, with the majority having an isolated reduction in diffusing capacity. Furthermore, a lower CD4 cell count was associated with a greater likelihood of a decreased DLCO. An impaired DLCO and fixed airflow obstruction were also more likely to be associated with chronic cough, phlegm, and dyspnea in HIV-infected compared with uninfected participants. Whether the decreased DLCO is due to emphysema or other processes such as pulmonary vascular disease or interstitial lung disease requires further evaluation and will have significant implications for patient care and for our understanding of the pathogenesis of HIV-related lung disease. Crothers JAIDS 2013 publication.
Apparently marijuana smoking may contribute to COPD.
Survival is worse in HIV+ with COPD.
Current smoking increased airway obstruction by 77% in HIV+.
We found that 47% of baseline smokers and 39% of nonsmokers had rapid decline in FEV1, defined using a common cutoff of >40 mL/yr. JAIDS 2018 MacDonald INSIGHT START Pulmonary
Substudy Group
Although this difference was not statistically significant (P = 0.09),.....Although there are limited data exploring incident COPD among HIV-positive individuals, our findings are remarkably consistent with a single-center study in Denmark where 63 HIV-positive patients underwent baseline and repeat spirometry over an average of 4.5 years. The prevalence of COPD increased from 20% to 33% (13% increase) among smokers and from 0% to 6% (6% increase) among nonsmokers.16 In addition to the increased risk of COPD, decreased lung function has been associated with increased mortality in HIV-positive individuals and in the general population.15,30-32
Marijuana use, lower body mass index, and prior lung infection tended to boost chances of COPD. 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.
http://www.natap.org/2014/CROI/croi_99.htm
HIV Infection Is Associated with an Increased Risk for Lung Cancer, Independent of Smoking......our data support the hypothesis that HIV infection increases lung cancer risk and provide evidence that this effect is independent of smoking status. In several prior studies of HIV-infected individuals, lung cancer risk was higher among injection drug users than among other HIV risk groups [6, 8, 10, 13]; perhaps this finding was related to differences in smoking habits [37]. Also, inhaling illicit drugs may promote the direct delivery of potential toxins or contaminants into the lungs, providing a biologically plausible mechanism for inducing local changes that could lead to lung cancer [38].
Because our study population was restricted to injection drug users, differences in smoking prevalence or intensity, as well as unrecognized potential confounders, have largely been adjusted for in the analyses. However, we found little evidence for a role of illicit drugs in the etiology of HIV-associated lung cancer.. ......If the increased risk of lung cancer among HIV-infected persons is not fully explained by smoking, further mechanisms can be postulated, including (1) an oncogenic role of HIV infection itself; (2) a direct consequence of HIV-related immunosuppression and decreased immune surveillance, similar to other AIDS-defining malignancies; (3) lung damage from recurrent infections, which are more common in HIV-infected persons; or (4) an HIV-mediated increase in susceptibility to tobacco carcinogens, such as through increases in genomic instability [24]. https://academic.oup.com/cid/article/45/1/103/479120?searchresult=1
Pdf attached
Download the PDF here
Cancer risk among the HIV-infected elderly in the United States - The most frequent cancers among men were prostate cancer (5-year cumulative incidence = 2.7%), lung cancer (2.4%), NHL (0.9%), colorectal cancer (0.9%), and anal cancer (0.8%). Among women, the most frequent cancers were lung cancer (5-year cumulative incidence = 1.6%), colorectal cancer (1.0%), breast cancer (1.0%), NHL (0.4%), and pancreatic cancer (0.3%)."
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. 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 http://www.natap.org/2016/HIV/012716_06.htm
from 2016 Comorbidities Wk: CT Signals of Chronic Lung Disease in HIV Patients Who Never Smoked
Almost 1 in 6 HIV-positive people in a large Italian clinic had CT signs of chronic lung disease--particularly emphysema--even though they never smoked [1]. The study tied emphysema to visceral and epicardial adiposity, findings leading the researchers to suggest that a common pathway links lung abnormalities and excess fat. The Modena team concluded that CT signs of chronic lung disease, particularly emphysema, are common in HIV-positive people who never smoked and probably represent a chronic subclinical lung injury. The associations between excess adipose tissue and emphysema, the researchers suggested, point to a common pathogenetic mechanism linking the two conditions. They noted that the associations between visceral and epicardial adipose tissue and lung disease reflect previous research linking at least excess visceral fat to COPD via inflammatory pathways (see conclusions in reference citations 2 and 3).
"The missing link between the two" conditions, the researchers suggested, may be "proinflammatory cytokines or tissue inflammatory agents" not assessed in this study. Guaraldi proposed that if (1) it affects HIV patients, (2) is a lung disease, (3) is chronic, and (4) is not obstructive, it is not COPD, but it may be CHPD: chronic HIV pulmonary disease.
COPD Markers Linked to Tripled Mortality Risk in People With HIV
Markers of chronic obstructive pulmonary disease (COPD) raised chances of mortality up to 3-fold in an analysis of 196 veterans with HIV [1]. None of the markers assessed had a similar impact in 165 HIV-negative veterans.
Alterations in oral microbiota in HIV-infected individuals related to pulmonary function - (10/16/18)
Plasma desmosine/isodesmosine and lung function among people with or at risk of HIV infection - (10/16/18)
20th International Workshop on
Co-morbidities and Adverse
Drug Reactions in HIV
October 13-14, 2018
|
|
| |
| |
|
|
|
