title: Chronic obstructive pulmonary disease: an emerging comorbidity in HIV-infected patients in the HAART era?
abstract: OBJECTIVE
  The objective of our study was to evaluate the presence of respiratory symptoms and chronic obstructive pulmonary disease (COPD) in a human immunodeficiency virus (HIV)-infected outpatient population and to further investigate the role of highly active antiretroviral therapy (HAART) and other possibly associated risk factors.
  
  
  METHODS
  We consecutively enrolled in a cross-sectional study HIV-infected patients and HIV-negative age, sex and smoking status matched controls. All participants completed a questionnaire for pulmonary symptoms and underwent a complete spirometry.
  
  
  RESULTS
  We enrolled 111 HIV-infected patients and 65 HIV-negative age- and sex-matched controls. HIV-infected patients had a significantly higher prevalence of any respiratory symptom (p = 0.002), cough (p = 0.006) and dyspnoea (p = 0.02). HIV-infected patients also had a significantly higher prevalence of COPD in respect of HIV-negative controls (p = 0.008). Furthermore, HIV-infected individuals had significantly (p = 0.002) lower forced expiratory volume at one second (FEV1) and FEV1/forced vital capacity (FVC) ratio (Tiffeneau index) (p = 0.028), whereas the total lung capacity (TLC) was significantly higher (p = 0.018). In the multivariate analysis, significant predictors of respiratory symptoms were current smoking [adjusted odds ratio (AOR) 11.18; 95 % confidence interval (CI) 3.89-32.12] and previous bacterial pneumonia (AOR 4.41; 95 % CI 1.13-17.13), whereas the only significant predictor of COPD was current smoking (AOR 5.94; 95 % CI 1.77-19.96). HAART receipt was not associated with respiratory symptoms nor with COPD.
  
  
  CONCLUSIONS
  We evidenced a high prevalence of respiratory symptoms and COPD among HIV-infected patients. HIV infection, current cigarette smoking and previous bacterial pneumonia seem to play a significant role in the development of respiratory symptoms and COPD. Thus, our results suggest that the most at-risk HIV-infected patients should be screened for COPD to early identify those who may need specific treatment.
authors.affiliation: Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Sassari, Via De Nicola 1, 07100, Sassari, Italy. giordano.madeddu@uniss.it
authors.forename: G
authors.initials: G
authors.lastname: Madeddu
authors.forename: A G
authors.initials: AG
authors.lastname: Fois
authors.forename: G M
authors.initials: GM
authors.lastname: Calia
authors.forename: S
authors.initials: S
authors.lastname: Babudieri
authors.forename: V
authors.initials: V
authors.lastname: Soddu
authors.forename: F
authors.initials: F
authors.lastname: Becciu
authors.forename: M L
authors.initials: ML
authors.lastname: Fiori
authors.forename: V
authors.initials: V
authors.lastname: Spada
authors.forename: C
authors.initials: C
authors.lastname: Lovigu
authors.forename: M
authors.initials: M
authors.lastname: Mannazzu
authors.forename: A
authors.initials: A
authors.lastname: Caddeo
authors.forename: B
authors.initials: B
authors.lastname: Piras
authors.forename: P
authors.initials: P
authors.lastname: Pirina
authors.forename: M S
authors.initials: MS
authors.lastname: Mura
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D016022:Case-Control Studies; D015897:Comorbidity; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D005541:Forced Expiratory Volume; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D017320:HIV Protease Inhibitors / Q000494:pharmacology; D006801:Humans; D008168:Lung / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000821:virology*; D012307:Risk Factors; D019438:Ritonavir / Q000494:pharmacology; D012907:Smoking / Q000009:adverse effects; D013147:Spirometry; D011795:Surveys and Questionnaires; D014109:Total Lung Capacity
chemical_list: D017320:HIV Protease Inhibitors; D019438:Ritonavir