Maintaining lung health with longstanding HIV

Area of Science:

• Pulmonology
• Infectious Diseases
• Oncology

Background:

• Human immunodeficiency virus (HIV) is now a chronic condition.
• Non-infectious lung conditions pose a greater threat than infections to lung health in aging HIV cohorts.
• There is no established consensus for maintaining long-term lung health in HIV-positive individuals.

Purpose of the Study:

• To review the epidemiology and pathogenesis of chronic obstructive pulmonary disease (COPD), pulmonary arterial hypertension (PAH), and lung cancer in HIV-seropositive individuals.

Main Methods:

• Literature review of epidemiology and pathogenesis.
• Analysis of prevalence data for COPD, PAH, and lung cancer in HIV-seropositive populations.
• Exploration of potential pathogenetic mechanisms including chronic inflammation, immune senescence, oxidative stress, and viral protein effects.

Main Results:

• COPD is up to 50% more prevalent in HIV-seropositive individuals.
• Significant pulmonary function impairment is found in 7% to over 50% of HIV-seropositive individuals.
• HIV-PAH prevalence is 0.2-0.5%, and lung cancer is 2-3 times more common in HIV-seropositive individuals.
• HIV is an independent contributor to COPD, PAH, and lung cancer pathogenesis.
• Non-infectious lung diseases are underrecognized, with limited evidence for effective screening.

Conclusions:

• COPD, PAH, and lung cancer represent a significant and growing threat to lung health in the era of highly active antiretroviral therapy.
• Early recognition of these non-infectious pulmonary conditions is essential for improved patient outcomes.
• Further research is needed to develop effective screening and management strategies for lung diseases in HIV-positive individuals.