Chronic obstructive pulmonary disease in HIV-infected adult patients at Moi Teaching and Referral Hospital

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality globally and its prevalence has been shown to be higher in HIV infected patients.HIV is thought to contribute to the occurrence of COPD via stimulation of inflammation, increased oxidative stress and endothelial cell apoptosis. Despite the high burden of HIV infection and other risk factors for COPD, local data on COPD in HIV infected patients is lacking. Objective: The objective of this study was to determine the prevalence of COPD and associated clinical & socio-demographic characteristics in HIV-infected patients at the Moi Teaching and Referral Hospital (MTRH). Methods: This was a cross-sectional study which was carried out at the AMPATH HIV clinic at MTRH from September 2014 to November 2014. HIV-infected adults aged 18 years and above were systematically recruited. Clinical and socio-demographic data were collected using interviewer administered structured questionnaire. Participants then underwent spirometry to determine their Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1) and FEV1/FVC ratio. Those whose initial FEV1/FVC ratio was <0.7 underwent repeat spirometry after a bronchodilator (salbutamol 400micrograms) challenge. COPD was defined as FEVI/FVC ratio <0.7 postbronchodilator challenge. Data analysis was done using STATA version 13 SE. A p value of less than 0.05 was considered statistically significant. Results: Of the 149 participants whose spirograms were acceptable and finally included in the analysis, 63 (42%) were male. The mean age was 44(SD 10) years. The median duration after HIV diagnosis was 6(IQR: 3-9) years. Those on ART were 120 (81%) with a median duration of 6(IQR:3-9) years. COPD was present in 6% (95% CL: 2.8%, 11.2%) of these patients. Patients with COPD were older (44 vs. 43 years, p=0.579). History of smoking was present in 17% of patients with a higher proportion among COPD patients (44% vs. 16%, p=0.050). History of pulmonary tuberculosis (PTB) was less in COPD patients (11% vs. 24%, p=0.348). A significantly higher proportion of patients with chronic respiratory symptoms had COPD compared asymptomatic ones (35.3% vs. 2.3%, p=0.0001). The main symptoms among COPD patients were: cough 44%, wheezing 44% and breathlessness 67%. Conclusion: The prevalence of COPD was 6% (95% CL: 2.8%, 11.2%) among HIV infected adult patients at MTRH. This is a substantial burden. Routine spirometry in these patients is recommended.