Chronic obstructive pulmonary disease prevalence and associated factors in an urban HIV clinic in a low income country

Abstract

Introduction In the last decade, survival of people living with HIV (PLHIV) has dramatically increased due wide availability of effective antiretroviral therapy. However, PLHIV remain at a comparatively higher risk of non-communicable comorbidities. We sought to determine the burden of COPD and its associations in an urban tertiary HIV clinic in Uganda. Methods and findings HIV-infected adults attending the Makerere University Joint AIDS program; aged ≥30 years without acute ailments were screened for COPD using study questionnaires and spirometry (post-bronchodilator FEV1/FVC<0.7). We determined its prevalence and association with demographic characteristics, body mass index (BMI) and known risk factors. Of 288 participants enrolled, 177 (61%) were female; 253 (88%) were from urban residences, median age was 45 years (IQR: 39–51), 71(25%) were ‘ever’ smokers, 284(99%) reported biomass fuel use and 72(25%) had a history of tuberculosis. All except 1 participant were on antiretroviral therapy, median current CD4 (cells/mm3) was 558 (IQR 402–753) and 275(96%) were virologically suppressed. Nearly half (130/288, 45%) had recurrent respiratory symptoms. The prevalence of COPD was 3.1% (9/288) [95% CI: 1.63–5.92]. COPD was associated with: previous tuberculosis, (adjusted odds ratio (AOR): 6.36, [95% CI 1.64–35.84], P = 0.036), self-reported chronic shortness of breath (AOR: 9.06, [95% CI 1.34–61.10], P = 0.024) and a BMI <21 Kg/m2 (AOR: 10.42 [95% CI: 1.61–100.00], P = 0.013). Conclusion In this HIV population, COPD prevalence was low and was associated with previous tuberculosis, self-reported chronic shortness of breath and BMI <21 Kg/m2.

Abnormal spirometric patterns and respiratory symptoms in HIV patients with no recent pulmonary infection in a periurban hospital in Ghana

“…However, the prevalence of OSP in their HIV patients and non-HIV controls were lower than what is reported in our study [16]. Other cross-sectional studies in HIV patients in sub-Saharan Africa have reported OSP prevalence between 3.1 -15.4% [9,[13][14][15][16][17], and a metanalysis reported the prevalence of OSP in HIV patients from 30 observational studies involving 151, 686 participants around the globe to be between 5.6% and 10.6% [6], similar to what was found in this study.…”

“…The prevalence of respiratory symptoms in our HIV population is similar to what has been reported in other sub-Saharan African populations. In urban Ugandan HIV patients, Ddungu et al reported the prevalence of any respiratory symptom to be 45%, with 30% reporting chronic cough, 21% reporting frequent phlegm production and wheezing and 26% reporting dyspnoea [14]. Similarly, in Cameroonian HIV patients, Pefura-Yone et al reported the prevalence of any respiratory symptom to be 47.5% while that of cough and dyspnoea were 25.5% and 36.4% respectively [16].…”

“…Despite the high prevalence of PLWH in SSA, few studies have reported the prevalence and risk factors for these abnormal spirometric patterns with recent reports from the FRESH AIR study in Uganda [5,6,[13][14][15][16][17]. Most of these studies attribute abnormal spirometry in HIV to opportunistic pulmonary infection.…”

HIV and chronic lung disease

“…Although much of the early literature on COPD in HIV was dominated by North American and European cohorts, more recently we have gained a greater sense of prevalence rates in sub-Saharan Africa. African participants in the Strategic Timing of Antiretroviral Therapy Trial, for instance, had a COPD prevalence rate of 7.8% [58], whereas other observational cohorts have estimated prevalence rates of between 2 and 6% in Uganda [55,57,59], 5% in Cameroon [46], and 22% in Nigeria [48]. To date, few reports have evaluated the trend of COPD prevalence or incidence over time, with conflicting results ranging between no significant change over the course of the cART era [76] to significant increases in prevalence over time [72].…”

“…The propensity of PLWH toward COPD was first noted in 1992 when Diaz and colleagues reported 4 PLWH who had emphysema-like bullous changes, air trapping, hyperinflation, and reduced diffusion capacity, but no previous history of pulmonary infections [40]. Since then, in the cART era, the estimated prevalence of COPD has ranged between as low as less than 5% to upwards of 60% of cohorts, with definitions as varied as self-report [41,42], spirometry-confirmed [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59], computed tomography (CT) presence of emphysema [60][61][62][63][64][65][66][67], International Classification of Diseases (ICD) diagnostic codes [68][69][70][71][72][73][74][75][76][77], or chart review [78,79]. A 2018 meta-analysis reported pooled prevalence values of 10.5-10.6% by spirometry, 5.6% by ICD diagnostic codes, and 8.7% by patient selfreport [80].…”