Health  Vol.3 No.4 , April 2011
Chronic obstructive pulmonary disease in adults with human immunodeficiency virus infection: a systematic review
Abstract: Objective: To determine the prevalence of chro- nic obstructive pulmonary disease (COPD) in adults with Human Immunodeficiency virus infection (HIV). Design: Systematic review of Medline, Embase, CINAHL, PsycINFO and references from identified papers. Study selection: Studies determining the prevalence of COPD in adults with HIV infection. Independent duplicate data extraction. Study quality was assessed in terms of whether consecutive patients were en- rolled, recruitment and follow-up periods were defined, <10% of subjects were lost to follow-up, subjects with missing data, method of COPD diagnosis and antiretroviral treatment were described. Data synthesis and results: Of the 911 citations identified, 8 North American studies conducted from 2005 to 2010 were reviewed. The demographics were: mean age 43 - 50.3yrs, >60% males, <50% African Americans, 37.1% - 83.3% active smokers, >60% on antiretroviral therapy. COPD was diagnosed by post-bronchodilator FEV1/FVC < 0.7 in three studies, by International Classification of Diseases (ICD-9) codes in three studies, by FEV1/FVC < 5% of lower adjusted normal in one and by pre- bronchodilator FEV1/FVC < 0.7 in another study. The prevalence was 10% - 35%, except for one study that recorded prevalence of 4% by postbronchodilator FEV1/FVC < 0.7, but <38% of patients with prebronchodilator FEV1/FVC < 0.7 had post-bronchodilator spirometry in that study. Conclusion: COPD is becoming increasingly common in HIV infected as they smoke and live longer due to efficient antiretrovirals. However, definite conclusions cannot be drawn and more longitudinal studies are needed. In the meantime health care providers should be vigilant to screen for undiagnosed COPD and hesitant to attribute respiratory symptoms solely to HIV infection.
Cite this paper: nullGiantsou, E. and Powrie, D. (2011) Chronic obstructive pulmonary disease in adults with human immunodeficiency virus infection: a systematic review. Health, 3, 218-227. doi: 10.4236/health.2011.34039.

[1]   Palella, F.J., Delaney, K.M., Moorman, A.C., Loveless, M.O., Fuhrer, J., Satten, G.A., Aschman D.J. and Holberg, S.D. (1998) Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. NEJM, 338, 853-860. |doi:10.1056/NEJM199803263381301

[2]   Braithwaite, R.S., Justice, A.C., Chang, C.C., Fusco, J.S., Raffanti, S.R., Wong, J.B. and Roberts, M.S. (2005) Estimating the proportion of patients infected with HIV who will die of comorbid diseases. American Journal of Medicine, 118, 890-898.

[3]   Beck, J.M., Rosen, M.J. and Peavy, H.H. (2001) Pulmonary complications of HIV infection. Report of the Fourth NHLBI Workshop. American Journal of Respiratory and Critical Care Medicine, 164, 2120-2126.

[4]   Diaz, P.T., King, M.A., Pacht, E.R., Wewerrs, M.D., Gadek, J.E., Nagaraja, H.N., Drake, J. and Clanton T.L. (2000) Increased susceptibility to pulmonary emphysema among HIV seropositive smokers. Annals of Internal Medicine, 132, 369-372.

[5]   Poirier, C.D., Inhaber, N., Lalonde, R.G and Ernst, P. (2001) Prevalence of bronchial hyperresponsiveness among HIV infected men. American Journal of Respiratory and Critical Care Medicine, 164, 542-545.

[6]   Tashkin, D.P., Altose, M.D., Connett, J.E., Kanner, R.E., Lee, W.W. and Wise, R.A. (1996) Metacholine reactivity predicts changes in lung function over time in smokers with early chronic obstructive pulmonary disease: The Lung Health Study Research Group. American Journal of Respiratory and Critical Care Medicine, 153, 1802- 1811.

[7]   Health Canada. (1999-2007) Canadian tobacco use monitor survey. Internet available:

[8]   Laurence, J. (2005) HIV and the lung in the HAART era. AIDS Read, 15, 327-330.

[9]   Morris, A., Alexander, T., Radhi, S., Lucht, L., Sciurba, F.C., Kolls, J.K., Srivastana, R., Steele, C. and Norris, K.A. (2009) Airway obstruction in increased in Pneumocystis colonized Human Immunodeficiency Virus infected outpatients. Journal of Clinical Microbiology, 47, 3773-3776. doi:10.1128/JCM.01712-09

[10]   Morris, A., Sciurba, F.C. and Norris, K.A. (2008) Pneumocystis: A novel pathogen in chronicobstructive pulmonary disease? Chronic Obstructive Pulmonary Disease, 5, 43-51. doi:10.1080/15412550701817656

[11]   Crothers, K. (2007) Chronic obstructive pulmonary disease in patients who have HIV infection. Clinics in Chest Medicine, 28, 575-587. doi:10.1016/j.ccm.2007.06.004

[12]   Crothers, K., Butt, A.A., Gibert, C.L., Rodriguez -Barradas, M.C., Crystal, S. and Justice, A.C. (2006) Increased COPD among HIV positive compared to HIV negative veterans. Chest, 130, 1326-1333. doi:10.1378/chest.130.5.1326

[13]   Juni, P., Altman, D.G. and Egger, M. (2001) Systematic reviews in health care. Assessing the quality of controlled clinical trials. British Medical Journal, 323, 224-228.

[14]   Stroup, D.F., Berlin, J.A., Morton, S.C., Olkin, I., Williamson, D.G., Rennie, D., Moher, D., Becker, D.G., Sipe, T.A. and Thacker, S.B. (2000) Meta-analysis of observational studies in epidemiology. A proposal for reporting. Journal of the American Medical Association, 283, 2008-2012. doi:10.1001/jama.283.15.2008

[15]   De Sousa, M.R. and Ribeiro, A.L.P. (2009) Systematic reviews and meta-analysis of diagnostic and prognostic studies a tutorial. Arquivos Brasileiros de Cardiologia, 92, 229-238.

[16]   United States National Library of Medicine. (2010) Medical subjects headings. Internet available:

[17]   Library of the Cochrane reviews. (2010) Internet available:

[18]   World Health Organization. (2010) WHO and HIV/AIDS. Internet available:

[19]   Moayyedi, P. (2004) Meta-analysis: Can we mix apples and oranges? American Journal of Roentgenology, 99, 2297-2301.

[20]   Low, N. and Egger, M. (1998) Can we predict the prognosis of HIV infection? How to use the findings of a prospective study. Sexually Transmitted Infections, 74, 149-154. doi:10.1136/sti.74.2.149

[21]   McGinnis, K.A., Fine, M.J., Sharma, R.K., Skanderson, M., Wagner, J.H., Rodriguez-Barradas, M.C., Rabeneck, L. and Justice, A.C. (2003) Understanding racial disparities in HIV using data from the veterans aging cohort-3 study and VA administrative data. American Journal of Public Health, 93, 1728-1733. doi:10.2105/AJPH.93.10.1728

[22]   British Thoracic Society. (2004) COPD guidelines. Internet available:

[23]   Celi, B.R., McNee, B.R. and ATS/ERS Task force. (2004) Standards for the diagnosis and treatment of patients with COPD. A sumary of the ATS-ERS position paper. European Respiratory Journal, 23, 932-946. doi:10.1183/09031936.04.00014304

[24]   American Thoracic Society. (2004) COPD guidelines. Internet available:

[25]   National Heart Lung, and Blood Institute and World Health Organization Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2009) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Internet available:

[26]   AHIMA. (2010) ICD-9-CM coding guidance for LTC facilities. Appendix B: Reporting and sequencing diagnoses on the health record and UB-04 claim form. Journal of AHIMA 81, 66-70.

[27]   Bossuyt, P.M., Reitsma, J.B., Bruns, D.E., Gatsonis, C.A., Glasziou, P.P., Irwig, L.M., Moher, D., Rennie, D., de Vet, H.C. and Lijmer, J.G. (2003) The STARD statement for reporting studies of diagnostic accuracy: Explanation and elaboration. Clinical Chemistry, 49, 7-18 doi:10.1373/49.1.7

[28]   Crothers, K., Griffith, T.A., McGinnis, K.A., Rodriguez-Barradas, M.C., Leaf, D.A, Weissman, S., Gilbert, C.L., Butt, A.A. and Justice, A.C. (2005) The impact of cigarette smoking on mortality, quality of life and comorbid illness among HIV-positive veterans. Journal of General Internal Medicine, 20, 1142-1145. doi:10.1111/j.1525-1497.2005.0255.x

[29]   Crothers, K., Huang, L., Goulet, J.L., Goetz, M.B., Brown, S., Rodriguez-Barradas, M., Oursler, K.K., Rimland, D., Gibert, C.L., Butt, A.A. and Justice, A.C. (2010) HIV infection and risk for incident pulmonary diseases in the combination antiretroviral therapy era. American Journal of Respiratory and Critical Care Medicine.

[30]   Cui, Q., Mclvor, A., Smail, F., Thabane, L. and Smieza, M. (2010) Effect of smoking on lung function, respiratory symptoms and respiratory diseases amongst HIV -positive subjects: A cross sectional study. Aids Research and Therapy, 7, 1-10.

[31]   Gingo, M.R., George, M.P., Kessinger, C.J., Lucht, L., Rissler, B., Weinman, R., Slivka, W.A., McMahon, D.K., Wenzel, S.E., Sciurba, F.C. and Morris, A. (2010) Pulmonary function abnormalities in HV-infected patients during the current antiretroviral therapy era. American Journal of Respiratory and Critical Care Medicine, 182, 790-796. doi:10.1164/rccm.200912-1858OC

[32]   George, M.P., Kannass, M., Huang, L., Sciurba, F.C. and Morris, A.B. (2009) Respiratory symptoms and airway obstruction in HIV-infected subjects in the HAART era. Public Library of Science, 4, 1-7.

[33]   Drummond, M.B., Kirk, G.D., Ricketts, E.P., McCor- mack, M.C., Haque, J.C., McDyer, J.F., Mehta, S.H., Engels, E.A., Wise, R.A. and Merlo, C.A. (2010) Cross sectional analysis of respiratory symptoms in an injection drug user cohort: The impact of obstructive lung disease and HIV. BMC Pulmonary Medicine, 10.

[34]   Burns, D., Hillman, D., Neaton, J.D., Sherer, R., Mitchell, T., Capps, L., Vallier, W.G., Thurnherr, M.D. and Gordin, F.M. (1996) Cigarette smoking, bacterial pneumonia and other clinical outcomes in HIV-1 infection. Terry Beirn Community programs for clinical research in AIDS. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 13, 374-383. doi:10.1097/00042560-199612010-00012

[35]   Niaura, R., Shadel, D.G., Morrow, K., Tashima, K., Flanigan, T. and Abrams, D.B. (2000) Human immunodeficiency virus infection, AIDS, and smoking cessation: The time is now. Clinical Infectious Diseases, 31, 808-812.

[36]   Justice, A.C., Lasky, E., McGinnis, K.A., Skanderson, M., Conigliaro, J., Fultz, S.L., Crothers, K., Rabeneck, L., Rodriguez-Barradas, M., Weissman, S.B. and Bryant. K. (2006) Medical disease and alcohol use among veterans with human immunodeficiency virus infection: A comparison of disease measurement strategies. Medical Care, 44, 52-60.

[37]   Quan, H., Parsons, G.A. and Ghali, W.A. (2002) Validity of information on comorbidity derived from ICD-9-CCM administrative data. Medic,” Medical Care, 40, 675-685. doi:10.1097/00005650-200208000-00007

[38]   Wilchesky, M., Tamblyn, R.M. and Huang, A. (2004) Validation of diagnostic codes within medical services claims. Journal of Clinical Epidemiology, 57, 131-141.

[39]   Lindberg, A., Johnsson, A.C., Ronmark, E., Lundgren, R., Larsson, L.G. and Lunback, B. (2005) Prevalence of chronic obstructive pulmonary disease according to BTS, ERS, GOLD and ATS criteria in relation to doctor’s diagnosis, symptoms, age, gender, and smoking habits. Respiration, 72, 471-479.

[40]   Matsumoto, T., Mike, T., Nelson, R.P., Trudeau, W.L., Lockey, R.F. and Yodoi, J. (1993) Elevated serum levels of IL-8 in patients with HIV-infection. Clinical & Experimental Immunology, 93, 149-151.

[41]   Lahdevirta, J., Maury, C.P., Teppo, A.M. and Repo, H. (1988) Elevated levels of circulating cachectin/tumor necrosis factor in patients with acquired immunodeficiency syndrome. American Journal of Medicine, 85, 289-291. doi:10.1016/0002-9343(88)90576-1

[42]   Kaner, R.J., Santiago, F. and Crystal, R.G. (2009) Up -regulation of alveolar matrix metalloproteinases in HIV1+ smokers with early emphysema. Leucoc Biology, 86, 913-922.

[43]   Morris, A., Huang, L., Bacchetti P, P., Turner, J., Hopewell, P.C., Wallace, J.M., Kvale, P.A., Rosen, M.J., Glassroth, J., Reichman, L.B. and Stansell, J.D. (2000) Permanent decline in pulmonary function following pneumonia in Human Immunodeficiency virus infected persons. American Journal of Respiratory and Critical Care Medicine, 162, 612-616.

[44]   Morris, A., Sciurba, F.C., Lebedeva, I.P., Githaiga, A., Elliot, M., Hoqq, J.C., Huang, L. and Norris, K.A. (2004) Association of chronic obstructive pulmonary disease severity and Pneumocystis colonization” American Jour- nal of Respiratory and Critical Care Medicine, 170, 408-413. doi:10.1164/rccm.200401-094OC

[45]   Desquilbet, L., Jacobson, L.P., Fried, L.P., Phair, J.P., Jamieson, B.D., Holloway, M. and Margolick, J.B. (2007) HIV-1 infection is associated with an earlier occurrence of a phenotype related to frailty. Journals of Gerontology Series A-Biological Sciences and Medical Sciences, 62, 1279-1286.

[46]   Cao, W., Jamieson, B.D., Hultin, L.E., Hultin, P.M., Effros, R.B. and Detels, R. (2009) Premature aging of T cells is associated with faster HIV-1 disease progression. Journal of Acquired Immune Deficiency Syndromes, 50, 137-147. doi:10.1097/QAI.0b013e3181926c28

[47]   Tenorio, A.R., Spritzler, J., Martinson, J., Gichinga, C.N., Pollard, R.B., Lederman, M.M., Kalayjian, R.C. and Landay, A.L. (2009) The effect of aging on T-regulatory cell frequency in HIV infection. Clinical Immunology, 130, 298-303. doi:10.1016/j.clim.2008.10.001

[48]   Appay, V., Almeida, J.R., Sauce, D., Autran, B. and Papagno, L. (2007) Accelerated immune senescence and HIV-1 infection. Experimental Gerontology, 42, 432-437. doi:10.1016/j.exger.2006.12.003

[49]   Ito, K. and Barnes, P.J. (2009) COPD as a disease of accelerated lung aging. Chest, 42, 173-180. doi:10.1378/chest.08-1419

[50]   MacNee, W. (2009) Accelerated lung aging: A novel pathogenic mechanism of chronic obstructive pulmonary disease (COPD). Biochemical Society Transactions, 37, 819-823. doi:10.1042/BST0370819

[51]   Nyunoya, T., Monick, M.M., Klingelhutz, A.T., Yarovinsky, A.O., Cagley, J.R. and Hunninghake, G.W. (2006) Cigarette smoke induces cellular senescence. American Journal of Respiratory Cell and Molecular Biology, 35, 681-688. doi:10.1165/rcmb.2006-0169OC

[52]   World Health Organization. Global epidemic data and statistics. A global view of HIV in 2008. Internet available: html.