scholarly journals An Emerging Syndemic of Smoking and Cardiopulmonary Diseases in People Living with HIV in Africa

2021 ◽  
Vol 18 (6) ◽  
pp. 3111
Author(s):  
Emmanuel Peprah ◽  
Mari Armstrong-Hough ◽  
Stephanie H. Cook ◽  
Barbara Mukasa ◽  
Jacquelyn Y. Taylor ◽  
...  
Keyword(s):  
Current Evidence ◽  
Chronic Obstructive ◽  
People Living With Hiv ◽  
African Countries ◽  
Obstructive Pulmonary Disease ◽  
Cardiopulmonary Disease ◽  
Current Trends ◽  
Significant Public Health ◽  
Artery Disease ◽  
Living With Hiv

Background: African countries have the highest number of people living with HIV (PWH). The continent is home to 12% of the global population, but accounts for 71% of PWH globally. Antiretroviral therapy has played an important role in the reduction of the morbidity and mortality rates for HIV, which necessitates increased surveillance of the threats from pernicious risks to which PWH who live longer remain exposed. This includes cardiopulmonary comorbidities, which pose significant public health and economic challenges. A significant contributor to the cardiopulmonary comorbidities is tobacco smoking. Indeed, globally, PWH have a 2–4-fold higher utilization of tobacco compared to the general population, leading to endothelial dysfunction and atherogenesis that result in cardiopulmonary diseases, such as chronic obstructive pulmonary disease and coronary artery disease. In the context of PWH, we discuss (1) the current trends in cigarette smoking and (2) the lack of geographically relevant data on the cardiopulmonary conditions associated with smoking; we then review (3) the current evidence on chronic inflammation induced by smoking and the potential pathways for cardiopulmonary disease and (4) the multifactorial nature of the syndemic of smoking, HIV, and cardiopulmonary diseases. This commentary calls for a major, multi-setting cohort study using a syndemics framework to assess cardiopulmonary disease outcomes among PWH who smoke. Conclusion: We call for a parallel program of implementation research to promote the adoption of evidence-based interventions, which could improve health outcomes for PWH with cardiopulmonary diseases and address the health inequities experienced by PWH in African countries.

scholarly journals Impact of human immunodeficiency virus on pulmonary vascular disease

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Ashok Kumar ◽  
Aatish Mahajan ◽  
Ethan A Salazar ◽  
Kevin Pruitt ◽  
Christian Arce Guzman ◽  
...  
Keyword(s):  
Vascular Disease ◽  
Clinical Manifestations ◽  
Pulmonary Vasculature ◽  
Pulmonary Vascular Disease ◽  
Chronic Obstructive ◽  
People Living With Hiv ◽  
Obstructive Pulmonary Disease ◽  
Advantages And Disadvantages ◽  
Complex Interactions ◽  
Living With Hiv

With the advent of anti-retroviral therapy, non-AIDS-related comorbidities have increased in people living with HIV. Among these comorbidities, pulmonary hypertension (PH) is one of the most common causes of morbidity and mortality. Although chronic HIV-1 infection is independently associated with the development of pulmonary arterial hypertension, PH in people living with HIV may also be the outcome of various co-morbidities commonly observed in these individuals including chronic obstructive pulmonary disease, left heart disease and co-infections. In addition, the association of these co-morbidities and other risk factors, such as illicit drug use, can exacerbate the development of pulmonary vascular disease. This review will focus on these complex interactions contributing to PH development and exacerbation in HIV patients. We also examine the interactions of HIV proteins, including Nef, Tat, and gp120 in the pulmonary vasculature and how these proteins alter the endothelial and smooth muscle function by transforming them into susceptible PH phenotype. The review also discusses the available infectious and non-infectious animal models to study HIV- associated PAH, highlighting the advantages and disadvantages of each model, along with their ability to mimic the clinical manifestations of HIV-PAH. 

scholarly journals Chronic obstructive pulmonary disease prevalence and associated factors in an urban HIV clinic in a low income country

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256121
Author(s):  
Ahmed Ddungu ◽  
Fred C. Semitala ◽  
Barbara Castelnuovo ◽  
Christine Sekaggya-Wiltshire ◽  
William Worodria ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Low Income ◽  
Chronic Obstructive ◽  
People Living With Hiv ◽  
Shortness Of Breath ◽  
Obstructive Pulmonary Disease ◽  
Low Income Country ◽  
Wide Availability ◽  
History Of ◽  
Living With Hiv

Introduction In the last decade, survival of people living with HIV (PLHIV) has dramatically increased due wide availability of effective antiretroviral therapy. However, PLHIV remain at a comparatively higher risk of non-communicable comorbidities. We sought to determine the burden of COPD and its associations in an urban tertiary HIV clinic in Uganda. Methods and findings HIV-infected adults attending the Makerere University Joint AIDS program; aged ≥30 years without acute ailments were screened for COPD using study questionnaires and spirometry (post-bronchodilator FEV1/FVC<0.7). We determined its prevalence and association with demographic characteristics, body mass index (BMI) and known risk factors. Of 288 participants enrolled, 177 (61%) were female; 253 (88%) were from urban residences, median age was 45 years (IQR: 39–51), 71(25%) were ‘ever’ smokers, 284(99%) reported biomass fuel use and 72(25%) had a history of tuberculosis. All except 1 participant were on antiretroviral therapy, median current CD4 (cells/mm3) was 558 (IQR 402–753) and 275(96%) were virologically suppressed. Nearly half (130/288, 45%) had recurrent respiratory symptoms. The prevalence of COPD was 3.1% (9/288) [95% CI: 1.63–5.92]. COPD was associated with: previous tuberculosis, (adjusted odds ratio (AOR): 6.36, [95% CI 1.64–35.84], P = 0.036), self-reported chronic 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 In this HIV population, COPD prevalence was low and was associated with previous tuberculosis, self-reported chronic shortness of breath and BMI <21 Kg/m2.

scholarly journals A study on co-morbidities and treatment outcome based on updated definitions among tuberculosis patients registered at a tuberculosis unit, Bangalore

2017 ◽  
Vol 4 (4) ◽  
pp. 1071
Author(s):  
Anwith H. H. Shivalingaiah ◽  
Chethana Ramegowda ◽  
N. R. Ramesh Masthi
Keyword(s):  
Treatment Outcome ◽  
Treatment Success ◽  
Public Health Problem ◽  
Chronic Obstructive ◽  
People Living With Hiv ◽  
Major Public Health Problem ◽  
Obstructive Pulmonary Disease ◽  
Tuberculosis Patients ◽  
Common Opportunistic Infection ◽  
Living With Hiv

Background: Tuberculosis remains one of the world‘s deadliest communicable diseases and a major public health problem and is a most common opportunistic infection in people living with HIV. The treatment outcome of Tuberculosis is influenced by numerous factors of which presence of co-morbidities is one of the factors. The present study was done with following objectives, to assess the proportion of co-morbidities and treatment outcome of the Tuberculosis cases registered for DOTS treatment at the Tuberculosis unit.Methods:  A Descriptive study was conducted at a Tuberculosis Unit in Bangalore with 80 subjects     selected by purposive sampling satisfying inclusion & exclusion criteria. Data was collected using a pretested semi structured proforma administered to all the study subjects by trained investigators. Data regarding socio demographic profile, profile of tuberculosis, medical co-morbidities which the subjects were suffering were collected and these patients were followed up till their treatment completion and outcome of treatment was given based on new WHO definitions.Results: The present study showed that, 38 (47.50%) of the study subjects had one or the other comorbidities with chronic obstructive pulmonary disease being the most common 18(22.5%) followed by Diabetes 13(16.25%). On determining the treatment outcome of the study subjects the overall treatment success rate was 86.25% which included the cured and treatment completed subjects. However there was no statistically significant (p = 0.614) association between treatment success and presence of comorbidity.Conclusions: The cure rate among the tuberculosis patients, following DOTS therapy was found to be slightly less than the RNTCP standards.

scholarly journals COVID-19 among people living with HIV: A systematic review

2020 ◽  
Author(s):  
Hossein Mirzaei ◽  
Willi McFarland ◽  
Mohammad Karamouzian ◽  
Hamid Sharifi
Keyword(s):  
Systematic Review ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Web Of Science ◽  
Google Scholar ◽  
Chronic Obstructive ◽  
People Living With Hiv ◽  
Specific Information ◽  
Obstructive Pulmonary Disease ◽  
Living With Hiv

This systematic review summarizes the evidence on the earliest patients with COVID-19-HIV co-infection. We searched PubMed, Scopus, Web of Science, Embase, preprint databases, and Google Scholar from December 01, 2019 to June 1, 2020. From an initial 547 publications and 75 reports, 25 studies provided specific information on COVID-19 patients living with HIV. Studies described 252 patients, 80.9% were male, mean age was 52.7 years, and 98% were on ART. Co-morbidities in addition to HIV and COVID-19 (multimorbidity) included hypertension (39.3%), obesity or hyperlipidemia (19.3%), chronic obstructive pulmonary disease (18.0%), and diabetes (17.2%). Two-thirds (66.5%) had mild to moderate symptoms, the most common being fever (74.0%) and cough (58.3%). Among patients who died, the majority (90.5%) were over 50 years old, male (85.7%), and had multimorbidity (64.3%). Our findings highlight the importance of identifying co-infections, addressing co-morbidities, and ensuring a secure supply of ART for PLHIV during the COVID-19 pandemic.

scholarly journals High prevalence of undiagnosed COPD among patients evaluated for suspected myocardial ischaemia

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000848 ◽  
Author(s):  
Andreas Jönsson ◽  
Artur Fedorowski ◽  
Gunnar Engström ◽  
Per Wollmer ◽  
Viktor Hamrefors
Keyword(s):  
Myocardial Ischaemia ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Clinical Factors ◽  
Obstructive Pulmonary Disease ◽  
Presenting Symptoms ◽  
High Prevalence ◽  
History Of ◽  
Artery Disease ◽  
Global Initiative

ObjectiveChronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) are leading causes of global morbidity and mortality. Despite the well-known comorbidity between COPD and CAD, the presence of COPD may be overlooked in patients undergoing coronary evaluation. We aimed to assess the prevalence of undiagnosed COPD among outpatients evaluated due to suspected myocardial ischemia.MethodsAmong 500 outpatients who were referred to myocardial perfusion imaging due to suspected stable myocardial ischaemia, 433 patients performed spirometry. Of these, a total of 400 subjects (age 66 years; 45% women) had no previous COPD diagnosis and were included in the current study. We compared the prevalence of previously undiagnosed COPD according to spirometry criteria from The Global Initiative for Chronic Obstructive Lung Disease (GOLD) or lower limit of normal (LLN) and reversible myocardial ischaemia according to symptoms and clinical factors.ResultsA total of 134 (GOLD criteria; 33.5 %) or 46 patients (LLN criteria; 11.5%) had previously undiagnosed COPD, whereas 55 patients (13.8 %) had reversible myocardial ischaemia. The presenting symptoms (chest discomfort, dyspnoea) did not differ between COPD, myocardial ischaemia and normal findings. Except for smoking, no clinical factors were consistently associated with previously undiagnosed COPD.ConclusionsAmong middle-aged outpatients evaluated due to suspected myocardial ischaemia, previously undiagnosed COPD is at least as common as reversible myocardial ischaemia and the presenting symptoms do not differentiate between these entities. Patients going through a coronary ischaemia evaluation should be additionally tested for COPD, especially if there is a positive history of smoking.

scholarly journals Prevalence and risk factors of pulmonary hypertension among adult patients with HIV infection in Ethiopia

2020 ◽  
Vol 10 (4) ◽  
pp. 204589402097151
Author(s):  
Dawit Kebede Huluka ◽  
Desalew Mekonnen ◽  
Sintayehu Abebe ◽  
Amha Meshesha ◽  
Dufera Mekonnen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Communicable Disease ◽  
Previous History ◽  
Systolic Pressure ◽  
Chronic Obstructive ◽  
Heart Catheterization ◽  
People Living With Hiv ◽  
Significant Difference ◽  
Living With Hiv

Globally, non-communicable diseases are increasing in people living with HIV. Pulmonary hypertension is a rare non-communicable disease in people living with HIV with a reported prevalence of <1%. However, data on pulmonary hypertension in people living with HIV from Africa are scarce and are non-existent from Ethiopia. This study aimed to examine the prevalence and severity of echocardiographic pulmonary hypertension and risk factors associated with pulmonary hypertension in people living with HIV in Ethiopia. A total of 315 consecutive adult people living with HIV followed at the Tikur Anbessa Specialized Hospital HIV Referral Clinic were enrolled from June 2018 to February 2019. Those with established pulmonary hypertension of known causes were excluded. A structured questionnaire was used to collect data on demographics, respiratory symptoms, physical findings, physician-diagnosed lung disease, and possible risk factors. Pulmonary hypertension was defined by a tricuspid regurgitant velocity of ≥2.9 m/sec on transthoracic echocardiography. A tricuspid regurgitant velocity ≥3.5, which translates into a pulmonary arterial pressure/right ventricular systolic pressure of ≥50 mmHg, was considered moderate-to-severe pulmonary hypertension. The mean age of the participants was 44.5 ± 9.8 years and 229 (72.7%) were females. Pulmonary hypertension was diagnosed in 44 (14.0%) of participants, of whom 9 (20.5%) had moderate-to-severe disease. In those with pulmonary hypertension, 17 (38.6%) were symptomatic: exertional dyspnea, cough, and leg swelling were seen in 12 (27.3%), 9 (20.5%), and 4 (9.1%), respectively. There was no significant difference in those with pulmonary hypertension compared to those without the disease by gender, cigarette smoking, previous history of pulmonary tuberculosis treatment, physician-diagnosed chronic obstructive pulmonary disease or bronchial asthma, duration of anti-retroviral therapy therapy or anti-retroviral regimen type. Pulmonary hypertension looks to be a frequent complication in people living with HIV in Ethiopia and is often associated with significant cardiopulmonary symptoms. Further studies using right heart catheterization are needed to better determine the etiology and prevalence of pulmonary hypertension in people living with HIV in Ethiopia compared to other countries.

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