Prevalence and Determinants of Chronic Obstructive Pulmonary Disease (COPD) in HIV+ Patients

Objectives

Main objective To determine the prevalence of COPD

Secondary objectives

• To determine the prevalence (and severity) of emphysema (HRCT)
• To Identify risk factors associated with the development of COPD and / or emphysema
• To analyze the predictive value of measuring DLCO as a marker of emphysema by HRCT
• To determine the prevalence of lung function abnormalities deeming specific drug treatment (bronchodilators, inhaled corticosteroids) in the absence of clinical symptoms
• To compare the pattern of inflammatory response in patients with COPD and / or emphysema, with and without HIV infection

Methodology:

Cross-sectional, descriptive, study of up to 350 patients with HIV infection.

All the patients will be be assessed with:

• an standardized clinical questionnaire
• full lung function tests
• high resolution CT scan
• induced sputum for bacterial culture, P. jiroveci, proinflamatory citokines (cytokines array)
• blood analysis: hemogram; basic biochemistry; HIV predictors; autoantibodies; proinflammatory citokines (ultrasensitive ELISA); C reactive protein (ultrasensitive nephelometry)
• exhaled gases (NO and CO)

Statistical analysis:

Description of the univariate distribution of the categorical or ordinal variables will be realized with a table of frequencies, and in quantitative variables by means of measures of central tendency (mean or median) and dispersion (standard deviation or 95 % confidence intervals). Depending on the normality of the distribution of variables, any comparisons will be assessed by means of parametric tests (T test; Chi2) or non parametric tests (Mann Whitney). To explore relationships between the variables of study, Kolgomorov-Smirnov for the comparison of groups and analysis of regression bivariate, and multivariate (logistic regression), will be conducted.

Inclusion criteria

• HIV infection in stable phase (minimum of three months)
• Being followed-up in external HUSD consultations (on a regular basis)
• Age 40-69 years

Exclusion criteria

• Chronic non-respiratory disease in terminal stage (stage IV or V of chronic kidney failure, heart failure, advanced chronic liver disease (Child C))
• Lack of cooperation
• Estimated survival of less than 1 year or Karnofsky <70
• Pregnancy
• Opportunistic infection in the last month
• Post lung resection
• Systemic treatment with corticosteroids, immunosuppressive chemotherapy or interferon at the time of inclusion