Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, USA.
Department of Genetic Medicine, Weill Cornell Medical College, New York, USA.
Expert Rev Respir Med. 2023 Jul-Dec;17(10):873-887. doi: 10.1080/17476348.2023.2272702. Epub 2023 Nov 24.
Since early in the HIV epidemic, emphysema has been identified among people with HIV (PWH) and has been associated with increased mortality. Smoking cessation is key to risk reduction. Health maintenance for PWH and emphysema should ensure appropriate vaccination and lung cancer screening. Treatment should adhere to inhaler guidelines for the general population, but inhaled corticosteroid (ICS) should be used with caution. Frontiers in treatment include targeted therapeutics. Major knowledge gaps exist in the epidemiology of and optimal care for PWH and emphysema, particularly in low and middle-income countries (LMIC).
Topics addressed include risk factors, pathogenesis, current treatment and prevention strategies, and frontiers in research.
There are limited data on the epidemiology of emphysema in LMIC, where more than 90% of deaths from COPD occur and where the morbidity of HIV is most heavily concentrated. The population of PWH is aging, and age-related co-morbidities such as emphysema will only increase in salience. Over the next 5 years, the authors anticipate novel trials of targeted therapy for emphysema specific to PWH, and we anticipate a growing body of evidence to inform optimal clinical care for lung health among PWH in LMIC.
自艾滋病流行早期以来，人们已经在 HIV 感染者（PWH）中发现了肺气肿，并发现其与死亡率增加有关。戒烟是降低风险的关键。PWH 和肺气肿的健康维护应确保适当的疫苗接种和肺癌筛查。治疗应遵循针对普通人群的吸入器指南，但应谨慎使用吸入性皮质类固醇（ICS）。治疗的前沿领域包括靶向治疗。在 PWH 和肺气肿的流行病学和最佳护理方面存在重大知识空白，特别是在低收入和中等收入国家（LMIC）。
涉及的主题包括危险因素、发病机制、当前的治疗和预防策略以及研究前沿。
在 LMIC 中，关于肺气肿的流行病学数据有限，而 COPD 导致的 90%以上的死亡都发生在这些国家，HIV 的发病率也最集中。PWH 的人口正在老龄化，年龄相关的合并症（如肺气肿）只会越来越突出。在未来 5 年内，作者预计会有针对 PWH 特有的肺气肿的靶向治疗的新试验，我们预计会有越来越多的证据来为 LMIC 中 PWH 的肺部健康提供最佳临床护理。
