title: Chronic obstructive pulmonary disease and HIV: are we appropriately screening?
abstract: Individuals with human immunodeficiency virus (HIV) represent a population that is at a higher risk of developing chronic obstructive pulmonary disease (COPD). In this study, we sought to determine the effects of smoking on respiratory symptoms and diseases among HIV-positive patients and to determine if symptomatic patients are being appropriately screened for COPD. HIV-positive individuals completed a self-administered questionnaire. The effects of smoking on respiratory symptoms and diseases were reported as odds ratios (ORs). The COPD screening criteria were adapted from the Canadian Thoracic Society (CTS) guidelines. Two hundred and forty-seven participants were recruited. The median age was 49 years; 75% were male and 92% were on highly active antiretroviral therapy. Smokers represented 66% of the population. Smoking had a statistically significant effect on respiratory symptoms including wheeze (OR 4.8 [95% confidence interval (CI) 1.6-14.2]), phlegm production (OR 4.9 [95% CI: 2.2-10.5]), cough (OR 7.0 [95% CI: 3.0-16.2]), and dyspnea (OR 7.2 [95% CI: 1.7-31.2]). Smoking had a higher odds of respiratory diseases including COPD (OR 4.9 [95% CI: 1.1-21.9]) and bronchitis (OR 3.8 [95% CI: 1.9-7.7]). Among HIV-positive smokers, 40% met the CTS screening criteria, while only 12% self-reported a diagnosis of COPD. The burden of smoking in the HIV population is significant. HIV-positive smokers are more likely to report both respiratory symptoms and diseases than HIV-positive non-smokers. A discrepancy exists between patients who met the CTS screening criteria and those who were diagnosed with COPD, raising the concern for under-recognition and under-diagnosis of COPD in this population.
authors.affiliation: a Department of Infectious Disease and Medical Microbiology , Michael G. DeGroote School of Medicine, McMaster University , Hamilton , Ontario , Canada.
authors.forename: Bahareh
authors.initials: B
authors.lastname: Ghadaki
authors.affiliation: b Department of Infectious Disease , Michael G. DeGroote School of Medicine, McMaster University , Hamilton , Ontario , Canada.
authors.forename: Nadine
authors.initials: N
authors.lastname: Kronfli
authors.affiliation: c Department of Clinical Epidemiology and Biostatistics , McMaster University , Hamilton , Ontario , Canada.
authors.forename: Thuva
authors.initials: T
authors.lastname: Vanniyasingam
authors.affiliation: d Division of Infectious Disease and Department of Medicine , Hamilton Health Sciences , Hamilton , Ontario , Canada.
authors.forename: Shariq
authors.initials: S
authors.lastname: Haider
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001991:Bronchitis / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D003371:Cough / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D012135:Respiratory Sounds; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: COPD; HIV; screening; smoking