scholarly journals Impact of human immunodeficiency virus on pulmonary vascular disease

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Ashok Kumar ◽  
Aatish Mahajan ◽  
Ethan A Salazar ◽  
Kevin Pruitt ◽  
Christian Arce Guzman ◽  
...  
Keyword(s):  
Vascular Disease ◽  
Clinical Manifestations ◽  
Pulmonary Vasculature ◽  
Pulmonary Vascular Disease ◽  
Chronic Obstructive ◽  
People Living With Hiv ◽  
Obstructive Pulmonary Disease ◽  
Advantages And Disadvantages ◽  
Complex Interactions ◽  
Living With Hiv

With the advent of anti-retroviral therapy, non-AIDS-related comorbidities have increased in people living with HIV. Among these comorbidities, pulmonary hypertension (PH) is one of the most common causes of morbidity and mortality. Although chronic HIV-1 infection is independently associated with the development of pulmonary arterial hypertension, PH in people living with HIV may also be the outcome of various co-morbidities commonly observed in these individuals including chronic obstructive pulmonary disease, left heart disease and co-infections. In addition, the association of these co-morbidities and other risk factors, such as illicit drug use, can exacerbate the development of pulmonary vascular disease. This review will focus on these complex interactions contributing to PH development and exacerbation in HIV patients. We also examine the interactions of HIV proteins, including Nef, Tat, and gp120 in the pulmonary vasculature and how these proteins alter the endothelial and smooth muscle function by transforming them into susceptible PH phenotype. The review also discusses the available infectious and non-infectious animal models to study HIV- associated PAH, highlighting the advantages and disadvantages of each model, along with their ability to mimic the clinical manifestations of HIV-PAH. 

scholarly journals An Emerging Syndemic of Smoking and Cardiopulmonary Diseases in People Living with HIV in Africa

2021 ◽  
Vol 18 (6) ◽  
pp. 3111
Author(s):  
Emmanuel Peprah ◽  
Mari Armstrong-Hough ◽  
Stephanie H. Cook ◽  
Barbara Mukasa ◽  
Jacquelyn Y. Taylor ◽  
...  
Keyword(s):  
Current Evidence ◽  
Chronic Obstructive ◽  
People Living With Hiv ◽  
African Countries ◽  
Obstructive Pulmonary Disease ◽  
Cardiopulmonary Disease ◽  
Current Trends ◽  
Significant Public Health ◽  
Artery Disease ◽  
Living With Hiv

Background: African countries have the highest number of people living with HIV (PWH). The continent is home to 12% of the global population, but accounts for 71% of PWH globally. Antiretroviral therapy has played an important role in the reduction of the morbidity and mortality rates for HIV, which necessitates increased surveillance of the threats from pernicious risks to which PWH who live longer remain exposed. This includes cardiopulmonary comorbidities, which pose significant public health and economic challenges. A significant contributor to the cardiopulmonary comorbidities is tobacco smoking. Indeed, globally, PWH have a 2–4-fold higher utilization of tobacco compared to the general population, leading to endothelial dysfunction and atherogenesis that result in cardiopulmonary diseases, such as chronic obstructive pulmonary disease and coronary artery disease. In the context of PWH, we discuss (1) the current trends in cigarette smoking and (2) the lack of geographically relevant data on the cardiopulmonary conditions associated with smoking; we then review (3) the current evidence on chronic inflammation induced by smoking and the potential pathways for cardiopulmonary disease and (4) the multifactorial nature of the syndemic of smoking, HIV, and cardiopulmonary diseases. This commentary calls for a major, multi-setting cohort study using a syndemics framework to assess cardiopulmonary disease outcomes among PWH who smoke. Conclusion: We call for a parallel program of implementation research to promote the adoption of evidence-based interventions, which could improve health outcomes for PWH with cardiopulmonary diseases and address the health inequities experienced by PWH in African countries.

scholarly journals Chronic obstructive pulmonary disease prevalence and associated factors in an urban HIV clinic in a low income country

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256121
Author(s):  
Ahmed Ddungu ◽  
Fred C. Semitala ◽  
Barbara Castelnuovo ◽  
Christine Sekaggya-Wiltshire ◽  
William Worodria ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Low Income ◽  
Chronic Obstructive ◽  
People Living With Hiv ◽  
Shortness Of Breath ◽  
Obstructive Pulmonary Disease ◽  
Low Income Country ◽  
Wide Availability ◽  
History Of ◽  
Living With Hiv

Introduction In the last decade, survival of people living with HIV (PLHIV) has dramatically increased due wide availability of effective antiretroviral therapy. However, PLHIV remain at a comparatively higher risk of non-communicable comorbidities. We sought to determine the burden of COPD and its associations in an urban tertiary HIV clinic in Uganda. Methods and findings HIV-infected adults attending the Makerere University Joint AIDS program; aged ≥30 years without acute ailments were screened for COPD using study questionnaires and spirometry (post-bronchodilator FEV1/FVC<0.7). We determined its prevalence and association with demographic characteristics, body mass index (BMI) and known risk factors. Of 288 participants enrolled, 177 (61%) were female; 253 (88%) were from urban residences, median age was 45 years (IQR: 39–51), 71(25%) were ‘ever’ smokers, 284(99%) reported biomass fuel use and 72(25%) had a history of tuberculosis. All except 1 participant were on antiretroviral therapy, median current CD4 (cells/mm3) was 558 (IQR 402–753) and 275(96%) were virologically suppressed. Nearly half (130/288, 45%) had recurrent respiratory symptoms. The prevalence of COPD was 3.1% (9/288) [95% CI: 1.63–5.92]. COPD was associated with: previous tuberculosis, (adjusted odds ratio (AOR): 6.36, [95% CI 1.64–35.84], P = 0.036), self-reported chronic shortness of breath (AOR: 9.06, [95% CI 1.34–61.10], P = 0.024) and a BMI <21 Kg/m2 (AOR: 10.42 [95% CI: 1.61–100.00], P = 0.013). Conclusion In this HIV population, COPD prevalence was low and was associated with previous tuberculosis, self-reported chronic shortness of breath and BMI <21 Kg/m2.

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