Respiratory symptoms in people living with HIV and the effect of antiretroviral therapy: a systematic review and meta-analysis

Brown, James; Roy, Anjana; Harris, Ross; Filson, Sarah; Johnson, Margaret; Abubakar, Ibrahim; Lipman, Marc

doi:10.1136/thoraxjnl-2016-208657

Cited by 26 publications

(22 citation statements)

References 39 publications

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“…As a result, AIDS-related morbidity and mortality have decreased markedly; however, aging with HIV has brought other challenges [ 1 ]. For instance, PLWH are more likely to develop chronic obstructive pulmonary disease (COPD) [ 2 ] and are also more likely to suffer from severe respiratory symptom burdens even after adjustment for smoking habits [ 3 ]. Although the pathogenesis of accelerated COPD in PLWH is poorly understood, the unique risk for pulmonary infections in this setting suggests that shifts in the lung microbiome might account for this phenomenon.…”

Section: Introductionmentioning

confidence: 99%

Decreased microbiome diversity in the HIV small airway epithelium

Tsai

Sze

et al. 2018

Respir Res

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BackgroundPersons living with human immunodeficiency virus (PLWH) face an increased burden of chronic obstructive pulmonary disease (COPD). Repeated pulmonary infections, antibiotic exposures, and immunosuppression may contribute to an altered small airway epithelium (SAE) microbiome.MethodsSAE cells were collected from 28 PLWH and 48 HIV- controls through bronchoscopic cytologic brushings. DNA extracted from SAE cells was subjected to 16S rRNA amplification and sequencing. Comparisons of alpha and beta diversity between HIV+ and HIV- groups were performed and key operational taxonomic units (OTUs) distinguishing the two groups were identified using the Boruta feature selection after Random Forest Analysis.ResultsPLWH demonstrated significantly reduced Shannon diversity compared with HIV- volunteers (1.82 ± 0.10 vs. 2.20 ± 0.073, p = 0.0024). This was primarily driven by a reduction in bacterial richness (23.29 ± 2.75 for PLWH and 46.04 ± 3.716 for HIV-, p < 0.0001). Phyla distribution was significantly altered among PLWH, with an increase in relative abundance of Proteobacteria (p = 0.0003) and a decrease in Bacteroidetes (p = 0.0068) and Firmicutes (p = 0.0002). Six discriminative OTUs were found to distinguish PLWH from HIV- volunteers, aligning to Veillonellaceae, Fusobacterium, Verrucomicrobiaceae, Prevotella, Veillonella, and Campylobacter.ConclusionsCompared to HIV- controls, PLWH’s SAE microbiome is marked by reduced bacterial diversity and richness with significant differences in community composition.Electronic supplementary materialThe online version of this article (10.1186/s12931-018-0835-7) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Decreased microbiome diversity in the HIV small airway epithelium

Tsai

Sze

et al. 2018

Respir Res

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“…This review reported that the best performing rule was the presence of any one of: current cough (any duration), fever, night sweats or weight loss with sensitivity of 78.9% (95% CI 58.3% to 90.9%) and specificity of 49.6% (95% CI 29.2% to 70.1%) . Another systematic literature review highlighted the importance of respiratory symptoms among HIV‐positive individuals , with a pooled odds ratio for the prevalence of cough of 3.05 (95% CI 2.24 to 4.16) among HIV‐positive compared to HIV‐negative individuals . HIV‐positive people remain at higher risk of respiratory symptoms even when started on ART, and are at increased risk of chronic lung disease from a variety of causes .…”

Section: Discussionmentioning

confidence: 99%

“…HIV‐positive people remain at higher risk of respiratory symptoms even when started on ART, and are at increased risk of chronic lung disease from a variety of causes . Ideally, advice on smoking cessation and links to specialist services providing diagnosis and management of infectious and non‐infectious causes of lung disease should be included as part of routine HIV care, along with regular screening for TB .…”

Section: Discussionmentioning

confidence: 99%

High HIV and active tuberculosis prevalence and increased mortality risk in adults with symptoms of TB: a systematic review and meta‐analyses

et al. 2018

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Introduction HIV and tuberculosis (TB) remain leading causes of preventable death in low‐ and middle‐income countries (LMICs). The World Health Organization (WHO) recommends HIV testing for all individuals with TB symptoms, but implementation has been suboptimal. We conducted a systematic literature review and meta‐analyses to estimate HIV and TB prevalence, and short‐term (two to six months) mortality, among adults with TB symptoms at community‐ and facility level.MethodsWe searched Embase, Global Health and MEDLINE databases, and reviewed conference abstracts for studies reporting simultaneous HIV and TB screening of adults in LMICs published between January 2003 and December 2017. Meta‐analyses were performed to estimate prevalence of HIV, undiagnosed TB and mortality risk at different health system levels.ResultsSixty‐two studies including 260,792 symptomatic adults were identified, mostly from Africa and Asia. Median HIV prevalence was 19.2% (IQR: 8.3% to 40.4%) at community level, 55.7% (IQR: 20.9% to 71.2%) at primary care level and 80.7% (IQR: 73.8% to 84.6%) at hospital level. Median TB prevalence was 6.9% (IQR: 3.3% to 8.4%) at community, 20.5% (IQR: 11.7% to 46.4%) at primary care and 36.4% (IQR: 22.9% to 40.9%) at hospital level. Median short‐term mortality was 22.6% (IQR: 15.6% to 27.7%) among inpatients, 3.1% (IQR: 1.2% to 4.2%) at primary care and 1.6% (95% CI: 0.45 to 4.13, n = 1 study) at community level.ConclusionsAdults with TB symptoms have extremely high prevalence of HIV infection, even when identified through community surveys. TB prevalence and mortality increased substantially at primary care and inpatient level respectively. Strategies to expand symptom‐based TB screening combined with HIV and TB testing for all symptomatic individuals should be of the highest priority for both disease programmes in LMICs with generalized HIV epidemics. Interventions to reduce short‐term mortality are urgently needed.

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“…A recent study from London of 197 HIV positive and 93 HIV negative participants specifically evaluated the prevalence of respiratory symptoms with the St George's Respiratory Questionnaire (SGRQ) and Medical Research Council (MRC) dyspnoea scale. It found a greater frequency of respiratory symptoms in PLWH, with a median SGRQ of 12 (IQR 6-25) vs 6 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) in controls, p<0.001. (4) As the minimum clinically important difference between groups is usually regarded as four, (5) this suggests that the PLWH had more reported symptoms.…”

Section: Respiratory Symptoms and Hivmentioning

confidence: 94%

HIV and respiratory illness in the antiretroviral therapy era

Jaffer¹,

Devani²,

Brown³

et al. 2017

Ann. Res. Hosp.

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Respiratory illness is a common manifestation of HIV infection. The availability of effective antiretroviral therapy (ART) has changed the pattern of respiratory ill-health experienced by people living with HIV (PLWH). Among populations with good access to ART, opportunistic respiratory infections such as Pneumocystis jirovecii pneumonia (PCP) are becoming less frequent. However, there is evidence to suggest that these populations may be at greater risk of serious non-AIDS illness including chronic respiratory disease. Although there is remaining uncertainty about the extent to which HIV represents an independent risk-factor for respiratory illness in individuals with a suppressed HIV viral load and immune reconstitution, in many settings PLWH have greater exposure to risk factors for respiratory illness (in particular tobacco smoking), which contribute to this burden of disease. As HIV-positive populations age, management of these conditions will therefore become increasingly important. Healthcare services need to manage this growing burden of chronic respiratory illness and provide access to preventative measures including smoking cessation and immunisation against vaccine-preventable respiratory infections in a way that is appropriate to the populations served.

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Respiratory symptoms in people living with HIV and the effect of antiretroviral therapy: a systematic review and meta-analysis

Cited by 26 publications

References 39 publications

Decreased microbiome diversity in the HIV small airway epithelium

Decreased microbiome diversity in the HIV small airway epithelium

High HIV and active tuberculosis prevalence and increased mortality risk in adults with symptoms of TB: a systematic review and meta‐analyses

HIV and respiratory illness in the antiretroviral therapy era

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