CLINICAL HIV AND AIDS JOURNAL (ISSN:2633-5476)

Despite the arrival of antiretroviral therapy (ART), the epidemic of the Human Immunodeficiency Virus (HIV) is still a global health crisis with a high burden of respiratory disease among infected people. While the first complications of the epidemic were fundamentally opportunistic infections, the improve of survival showed the appearance of non-infectious diseases that are associated with chronic respiratory symptoms and lung impairment [1].

Obstructive ventilatory defects and reduced diffusion capacity are common findings in adults, and the association between HIV and chronic obstructive pulmonary disease is increasingly recognized. There is synergy between viral factors, opportunistic infections, conventional influences such as tobacco smoke and exposure to biomass fuel, and potentially. The immunological effects of ART in the development of chronic obstructive pulmonary disease associated with HIV [2-4].

The effectiveness of antiretroviral therapy in controlling HIV infection has led to the highest HIV positive population at risk of chronic diseases. Through an exhaustive search of main databases, this review summarizes the information on associations between Chronic Obstructive Pulmonary Disease (COPD), asthma, and HIV infection. Asthma and COPD are more prevalent in populations infected with HIV; 16-20% of individuals with HIV infection suffer from it. When the infection is poorly controlled, it worsens spirometric capacity, accelerating the decline in lung function by approximately 55 to 75 ml/year.

It has been observed that up to 21% of HIV infected population have obstructive ventilatory defects and HIV reduces the diffusion capacity in more than 50% of patients [5, 6].

Recent studies of lung function in people infected with HIV have shown a high prevalence of airway obstruction, altered bronchodilator reversibility and impairment of diffusion capacity. Compared to people not infected with HIV and people with well-controlled HIV disease, people infected with HIV with high viral load or lower CD4 cell count have more airflow obstruction, a greater decrease in lung function and possibly more serious diffusion impairment [7].

Individuals infected with HIV seem to have an increased risk of obstructive lung diseases, although this represents the increase of emphysema, chronic bronchitis, asthma, or a combination of these disorders has not been fully evaluated. Although part of the increase in obstructive pulmonary disease, especially COPD, may be related to smoking and drug abuse, the apparent risk of COPD remains high in people infected with HIV. Recent studies of lung function in HIV-infected persons have elucidated some factors that may be important in the pathogenesis of obstructive pulmonary disease in HIV such as: a poor control of HIV contributes to COPD and decreased lung function, metabolic disease and inflammation associated with asthma and airway hyper reactivity [8]. 

Drummond and Shirley5 showed an accelerated decrease in respiratory function (FEV1 and FVC) in patients with low CD4 levels. Madeddu et al. concludes that the HIV virus is the most likely risk factor for COPD regardless of age and smoking habit [4]. Study by Popescu et al. demonstrated a significant correlation between the CD4 count in bronchoalveolar fluid and COPD in seropositive patients [9]. Recent study by Makinson et al. showed that COPD was not associated with Hepatitis C but significantly associated with HIV status in smokers aged more than 40 years [10].

Risso et al. in his study he investigated other factors that could be correlated with COPD [11]. One of them is the body mass index (BMI) which is associated with poor COPD prognosis when it is low. Other factors were studied such as the use of cannabis, use of intravenous drugs, depression, low viral replication activity and no significant relationship was found.

In his study the CD4 count below its normal value if it is associated with COPD. It also shows as aggravating factors the exposure to smoke and aging.

Chronic lung disease will become the third most common cause of death by 2030 in the general population. Early detection and proper management is a priority to improve the prognosis and quality of life of patients. In turn, the diagnosis of COPD reinforces smoking cessation, involves a thorough study of pulmonary function by spirometry, 6-minute walk test and carbon dioxide diffusion test (CDDT) and lung cancer screening [10, 12-14]. 

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