College of Health Sciences, Makerere University, Kampala, Uganda.
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
COPD. 2020 Jun;17(3):297-305. doi: 10.1080/15412555.2020.1769583. Epub 2020 May 28.
In Sub-Saharan Africa, COPD remains prevalent but its association with HIV is not well characterized especially in rural settings. We assessed for COPD prevalence, associated factors and lung function profile among HIV-infected individuals attending ART clinics in rural Nakaseke district of Uganda. We enrolled HIV-positive participants from four HIV treatment centers in rural Uganda. Participants underwent spirometry testing following standard guidelines. We defined COPD as a post-bronchodilator FEV/FVC ratio less than the fifth percentile of the NHANES III African-American reference. We assessed for factors associated with COPD and lung function profiles using multivariable logistic and linear regression analyses. We analyzed data from 722 HIV-positive participants (mean age 48.0 years, 59.7% women). Over 90% of participants were on ART for a median duration of 4 years (IQR 2-7 years), with a median viral load of 0 copies/mL (IQR 0-0 copies/mL), current and baseline CD4 + T cell count of 478 cells/mm (IQR 346-663 cells/mm) and 335 cells/mm (IQR 187-523 cells/mm) respectively. The prevalence of COPD was 6.22%. COPD was associated with worse respiratory symptoms and health status. History of pulmonary tuberculosis was strongly associated with COPD (adjusted OR = 4.92, 95% CI 1.71 to 14.15, = 0.003) and reduced lung function. Use of ART, CD+T cell count and viral load were not associated with COPD or reduced lung function. In conclusion, we report a COPD prevalence of 6.22% in HIV-infected individuals in rural Uganda. Pulmonary tuberculosis remains the strongest predictor of COPD risk and reduced lung function in well-controlled HIV.
在撒哈拉以南非洲，COPD 仍然很普遍，但它与 HIV 的关系尚未得到很好的描述，尤其是在农村地区。我们评估了乌干达农村纳卡塞克区接受抗逆转录病毒治疗的 HIV 感染者中 COPD 的患病率、相关因素和肺功能特征。我们从乌干达农村的四个 HIV 治疗中心招募了 HIV 阳性参与者。参与者按照标准指南进行了肺活量测定。我们将支气管扩张剂后 FEV/FVC 比低于 NHANES III 非裔美国人参考值第 5 百分位数的患者定义为 COPD。我们使用多变量逻辑回归和线性回归分析评估与 COPD 相关的因素和肺功能特征。我们分析了来自 722 名 HIV 阳性参与者的数据（平均年龄 48.0 岁，59.7%为女性）。超过 90%的参与者接受 ART 治疗的中位时间为 4 年（IQR 2-7 年），中位病毒载量为 0 拷贝/ml（IQR 0-0 拷贝/ml），当前和基线 CD4+T 细胞计数分别为 478 个细胞/mm（IQR 346-663 个细胞/mm）和 335 个细胞/mm（IQR 187-523 个细胞/mm）。COPD 的患病率为 6.22%。COPD 与更严重的呼吸道症状和健康状况有关。肺结核病史与 COPD 强烈相关（调整后的 OR=4.92，95%CI 1.71 至 14.15，=0.003），且与肺功能降低有关。ART 的使用、CD4+T 细胞计数和病毒载量与 COPD 或肺功能降低无关。总之，我们报告了乌干达农村 HIV 感染者中 COPD 的患病率为 6.22%。肺结核仍然是 HIV 控制良好患者 COPD 风险和肺功能降低的最强预测因素。
