title: HIV and chronic obstructive pulmonary disease: is it worse and why?
abstract: Smoking-related diseases, such as chronic obstructive pulmonary disease (COPD), are of particular concern in the HIV-infected population. Smoking rates are high in this population, and long-term exposure to cigarette smoke in the setting of HIV infection may increase the number of complications seen. Before the era of combination antiretroviral therapy, HIV-infected persons were noted to have an accelerated form of COPD, with significant emphysematous disease seen in individuals less than 40 years old. Unlike many of the AIDS-defining opportunistic infections, HIV-associated COPD may be more common in the current era of HIV because it is frequently reported in patients without a history of AIDS-related pulmonary complications and because many aging HIV-infected individuals have had a longer exposure to smoking and HIV. In this review, we document the epidemiology of HIV-associated COPD before and after the institution of combination antiretroviral therapy, review data suggesting that COPD is accelerated in those with HIV, and discuss possible mechanisms of HIV-associated COPD, including an increased susceptibility to chronic, latent infections; an aberrant inflammatory response; altered oxidant-antioxidant balance; increased apoptosis associated with HIV; and the effects of antiretroviral therapy.
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. morrisa@upmc.edu
authors.forename: Alison
authors.initials: A
authors.lastname: Morris
authors.forename: M Patricia
authors.initials: MP
authors.lastname: George
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
authors.forename: Laurence
authors.initials: L
authors.lastname: Huang
authors.forename: Lorrie
authors.initials: L
authors.lastname: Lucht
authors.forename: Cathy
authors.initials: C
authors.lastname: Kessinger
authors.forename: Eric C
authors.initials: EC
authors.lastname: Kleerup
mesh_terms: D000402:Airway Obstruction / Q000453:epidemiology / Q000503:physiopathology; D000818:Animals; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D017209:Apoptosis; D015551:Autoimmunity / Q000502:physiology; D042783:Endothelial Cells / Q000473:pathology; D004847:Epithelial Cells / Q000473:pathology; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D015438:Health Behavior; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D008168:Lung / Q000378:metabolism / Q000382:microbiology / Q000473:pathology; D008264:Macrophages / Q000378:metabolism; D018384:Oxidative Stress / Q000502:physiology; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology / Q000503:physiopathology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000503:physiopathology*; D012129:Respiratory Function Tests; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D019966:Substance-Related Disorders / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents