Chronic Obstructive Pulmonary Disease in People with HIV: an Evidence-Based Review

HIV co-infection is a risk factor for the development of COPD. HIV enhances the deleterious effects of exposures such as tobacco smoking, as well as interacting with other drivers of COPD such as pulmonary tuberculosis, air pollution and biomass fuel burning. Recent work demonstrates that HIV also contributes independently to COPD pathogenesis by promoting oxidative stress, chronic inflammation, abnormal innate and adaptive immune responses, microbial dysbiosis, and epigenetic alterations within the lung. Consequently, people with HIV develop COPD younger, more often, and with faster rates of lung function decline compared to seronegative individuals. They may also have distinct patterns of lung function abnormalities compared to other etiotypes of COPD. Understanding the natural and pathogenetic history of HIV-associated COPD is important as its assessment, prevention and treatment are currently extrapolated from the general population. Whilst smoking cessation remains vital, further understanding may help guide unique management strategies for HIV-associated COPD. In this review, we explore its epidemiology and pathophysiology and discuss prevention and treatment approaches in this increasingly common disease.