Chronic Lung Disease in HIV Patients

This narrative review discusses literature on chronic obstructive pulmonary disease (COPD) in people living with HIV (PLWH). Existing data indicate that HIV itself, independent of smoking, constitutes a pathogenic agent implicated in this disease condition. COPD can be viewed not exclusively as a pulmonary disease but rather as a systemic syndrome sparked and fueled by a persistent low-grade HIV-attributable inflammatory state. We speculate that even in the absence of airflow obstruction on spirometry, HIV-related lung disease can manifest with respiratory symptoms and structural lung derangement. Although not fully satisfying the global initiative for obstructive lung disease criteria for COPD, this phenotype of small airways lung disease is related to significant impairment of lung health and is associated with a high comorbidity burden. Within the specific context of the aging epidemic affecting HIV patients characterized by a high burden of comorbidities, frailty, and disabilities HIV-related lung disease has to be fit into the framework of the general comorbidity burden that PLWH experience, due to both HIV infection and to incidental HIV-unrelated risk factors. In this review, we will also provide a list of research gaps and an agenda for future studies in HIV patients.