There are higher rates of poor respiratory health in people ageing with HIV than in carefully matched HIV-negative people, with symptoms strongly associated with worse mental health and quality of life, Aidsmap reports. Professor Caroline Sabin presented these data from the POPPY study to the virtual British HIV Association (BHIVA) conference this week.
Higher rates of respiratory problems, including chronic obstructive pulmonary disease (COPD), have previously been reported in people with HIV, although the reasons for this are not clear, writes Roger Pebody in the Aidsmap article published on 24 November 2020.
Smoking is the most important risk factor for poor respiratory health, and this is more common in people with HIV than the general population, while recreational drug use can also contribute.
People living with HIV, especially those who had previously spent time without HIV treatment or with a low CD4 count, may also be more vulnerable due to legacy effects of untreated HIV or having had a respiratory infection (such as pneumonia or tuberculosis) in the past.
POPPY is an observational, cross-sectional study involving three groups of people:
- Older people living with HIV, aged over 50.
- Younger people living with HIV, aged below 50.
- Older HIV-negative controls, aged over 50.
The HIV-negative control group were mostly recruited at sexual health clinics and community settings in order to provide a group with similar demographic and lifestyle factors to the older group of people with HIV. They were matched in terms of age, ethnicity, sexual orientation and geography, Aidsmap continues.
Respiratory symptoms were assessed by self-report, rather than clinical evaluation. See details of the study in the full Aidsmap report, via the link below.
Roger Pebody continues in Aidsmap that symptoms suggestive of bronchitis were found in 14% of older people with HIV, 9.2% of younger people with HIV and 3.3% of older HIV-negative people.
Bronchitis symptoms were more common in current- and ex-smokers, but again there was no consistent association with HIV-related factors. After adjustment, both younger and older people with HIV were around four times more likely to have bronchitis than the HIV-negative controls.
The lack of a link between respiratory problems and immune dysfunction (at the time of the survey or in a patient’s history) surprised the researchers. It suggests that the higher rate of respiratory problems in people with HIV “may reflect unmeasured lifestyle, demographic or laboratory factors rather than specific disease effects or legacy effects of HIV disease per se.”
However, the researchers found very strong associations between respiratory symptoms, mental health and quality of life. Those with respiratory symptoms, including bronchitis symptoms, reported more symptoms of depression, low energy, problems doing some physical activities, restrictions on social life, and so on, Aidsmap reports.
Respiratory symptoms and chronic bronchitis in people with and without HIV infection
HIV Medicine. On ahead of print, 6 September 2020 (open access).
CA Sabin, KM Kunisaki, E Bagkeris, FA Post, M Sachikonye, M Boffito, J Anderson, PWG Mallon, I Williams, JH Vera, M Johnson, D Babalis and A Winston
High rates of respiratory symptoms and chronic bronchitis (CB) are reported in people with HIV infection (PWH). We investigated the prevalence of respiratory symptoms and CB in PWH and HIV‐negative people in the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) study.
Assessment of respiratory symptoms and CB was undertaken using the modified form of the St. George’s Respiratory Questionnaire for chronic obstructive pulmonary disease (COPD). Univariate (χ2 tests, Mann–Whitney Utests and Spearman’s rank correlation) and multivariable (linear and logistic regression) analyses were performed to consider associations of respiratory symptoms with demographic, lifestyle and HIV‐related parameters, and with depressive symptoms and quality of life.
Among the 619 participants, respiratory Symptom scores were higher in older and younger PWH compared to older HIV‐negative people, with median (interquartile range) scores of 17.7 (6.2, 39.5), 17.5 (0.9, 30.0) and 9.0 (0.9, 17.5), respectively (P = 0.0001); these differences remained significant after confounder adjustment.
Sixty‐three participants (10.2%) met the criteria for CB [44 (14.0%) older PWH, 14 (9.2%) younger PWH, and five (3.3%) older HIV‐negative people; P = 0.002], with these differences also remaining after adjustment for confounding variables, particularly smoking status [older vs. younger PWH: odds ratio (OR) 4.48 (95% confidence interval (CI) 1.64, 12.30); P = 0.004; older PWH vs. HIV‐negative people: OR 4.53 (95% CI 1.12, 18.28); P = 0.03].
Respiratory symptoms and CB were both associated with greater depressive symptom scores and poorer quality of life. No strong associations were reported between CB and immune function, HIV RNA or previous diagnosis of any AIDS event.
Respiratory symptoms and CB are more common in PWH than in demographically and lifestyle‐similar HIV‐negative people and are associated with poorer mental health and quality of life.
Aidsmap article – Respiratory problems and bronchitis more common in people with HIV
HIV Medicine article – Respiratory symptoms and chronic bronchitis in people with and without HIV infection