Prevalence of chronic obstructive pulmonary disease and associated factors among HIV infected patients attending the Mulago ISS Clinic

Abstract

Background: Chronic obstructive pulmonary disease (COPD) will be the 3rd leading cause of death worldwide by 2020. Data from Africa indicate that the prevalence of COPD is high (4% to 25%). We sought to determine its association with HIV in an urban ambulatory HIV clinic in Uganda. Methods: HIV-infected adults attending the Mulago ISS (HIV) clinic at Makerere University Joint AIDS program; aged ≥30 years without acute ailments were screened for COPD using validated questionnaire interviews and spirometry. COPD was defined using the Global Initiative for Obstructive Lung Disease criteria using a post-bronchodilator forced expiratory volume in one second to forced vital capacity ratio of <0.7. COPD prevalence was calculated and its association with demographic characteristics, body mass index (BMI) and risk factors (biomass fuel, opportunistic infections, smoking) was tested using logistic regression models. Results: Between October and December 2016, 306 participants were consecutively enrolled, 288 of whom provided acceptable spirometry and were included in final analysis. Of these 177 (61%) were female; 162 (56%) resided in urban settings, median age was 45 years (IQR: 39-51 years), 71(25%) were ‘ever’ smokers, 284(99%) reported chronic biomass exposure, 72 (25%) had previously suffered from TB. Chronic respiratory symptoms were common; cough (30%), sputum production (21%), shortness of breath (23%) and wheeze (21%) and overall 130(45%) reported at least one symptom. Of the 287 on ART, 275 (96%) had viral loads <75 viral copies/ml. The prevalence of COPD was 3.1% (9/288) [95% CI: 1.63-5.92] with 7/9 COPD patients reporting previous TB treatment. At multivariable analysis, COPD was associated with; history of previous TB treatment (adjusted Odds Ratio (aOR): 6.36, [95% CI 1.64-35.84], p=0.036), shortness of breath (aOR: 9.06, [95% CI 1.34-61.10], p=0.024) and a BMI <21 Kg/m2(aOR: 10.42 [95% CI: 1.61-100.00], p=0.013).

Conclusion: The prevalence of COPD is low in this HIV-infected population. History of previous TB, self-reported chronic shortness of breath and a BMI <21 Kg/m2 is associated with COPD. We recommend that HIV infected patients presenting with chronic dyspnea, history of previous TB and low BMI in the absence of acute infections should be proactively screened for COPD.