Chronic obstructive pulmonary disease in HIV-1 positive patients at the Yaounde Jamot Hospital: prevalence and correlates

Gaspary FODJEU (gaspa112@yahoo.com)
Internal medicine, University of Yaounde I
June, 2013
 

Abstract

Introduction

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and is on a rise. Its risk factors are numerous and tobacco smoking is known to be the principal risk factor. Others include: exposure to biomass, age, drug use, malnutrition, environmental and professional pollutants just to name a few. Yet our understanding of these risks factors is still incomplete. The role of new risk factors such as HIV infection and its treatment remains controversial.
In sub-Saharan Africa, the region in the world with the largest number of people living with HIV and relative low levels of tobacco smoking, no study to our knowledge has been done to assess the characteristics of COPD in HIV infected patients.
Objectives
- To determine the prevalence of COPD in patients infected with HIV-1 at the Yaounde Jamot Hospital (YJH);
- To investigate the characteristics of HIV-1 infected patients with COPD as compared to HIV-1 infected patients without COPD.

Methods

It was a cross-sectional study carried out over a period of 2 ½ months from 26th November 2012 to 16th February 2013 at the Approved Treatment Centre (ATC) for the care of HIV infection of the Yaounde Jamot Hospital. A systematic sampling of one in every four patients was conducted among all patients treated with antiretroviral drugs (ARVs) from Mondays to Thursday. All ARV-naive patients seen at the CTA during the study period were also invited to participate in the study. A questionnaire inspired from the ATS (American Thoracic Society)-78 respiratory survey questionnaire and the St George’s Respiratory Questionnaire for COPD Patients (SGRQ-C) was filled for each patient. All patients included performed spirometry according to ATS 2005 standards, to obtain forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and FEV1 / FVC ratio. COPD was defined as FEV1 / FVC ratio < the lower limit of normal after inhalation of 400 µg of salbutamol and an absence of complete reversibility. Furthermore, the prevalence of COPD was calculated as the proportion of patients with a non-reversible ventilator obstruction (VO). Multivariate logistic regression was used to investigate the characteristics of HIV-1infected patients with COPD.

Results

Of the 461 patients finally included, 312 (67.7%) patients were female and their ages ranged between 20-83 years with a median (1st-3rd quartiles) of 42 (35-49) years. Three hundred and ninety three (85.2%) patients were on ART for at least 3 months.
The prevalence of COPD was 5.2% (95% confidence interval CI: 3.2%-7.2%). The characteristics of patients with COPD were: the existence of a past history of pulmonary tuberculosis [adjusted odds ratio (95% CI): 3.590 (1.392-9.257), p = 0.008], the moderate or high exposure to biomass [2.472 (1.018-6.007), p = 0.046], the presence of chronic respiratory symptoms [4.019 (1.501-10.759), p = 0.006] and a body mass index (BMI) < 20Kg/m2 [4.392 (1.540-12.525) , p = 0.093].
Conclusion
This work has allowed us to assess the burden of COPD and its characteristics in HIV-1 infected patients in a fairly large population of HIV-1 positive patients. The prevalence of COPD is 5.2% (95% CI: 3.2%-7.2%) among HIV-1 infected patients. A past history of pulmonary TB, moderate-high exposure to biomass, presence of chronic respiratory symptoms and BMI < 20Kg/m2 are more frequent among HIV-1 patients with COPD than in HIV-1 patients without COPD. Therefore, the prompt identification of these factors found in this study among HIV-1 infected patients should allow earlier diagnosis of this disease in these patients and optimize their care.

Recommendation

Researchers:
- To carry out similar studies in other African communities in order to compare our findings to those of Western countries;
- Undertake a study including HIV-negative patients to elucidate the role of HIV infection in the occurrence of COPD.
Clinicians:
- Use the factors associated with COPD identified in this study for early diagnosis of COPD in patients infected with HIV.


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