Chronic Obstructive Pulmonary Disease Prevalence and Associated Factors in a Setting of Well-Controlled HIV, A Cross-Sectional Study

Figures & data

Figure 1. Screening and enrollment flow chart for study participants.

Table 1. Socio-demographic and clinical characteristics of the study participants stratified by COPD.

Characteristics	COPD-positive N = 45	COPD-negative N = 677	p-value
Sex
Female	37.7% (17)	61.0% (413)	0.002
Male	62.2% (28)	39.0% (264)
Age group (years)
35–39	15.6% (7)	20.4% (138)	0.05
40–44	8.9% (4)	23.8% (161)
45–54	51.1% (23)	35.9% (243)
55–80	24.4% (11)	19.9% (135)
BMI (kg/m^2)
<18.5	37.8% (17)	14.2% (96)	<0.001
18.5–24.9	60.0% (27)	68.5% (464)
25–29.9	2.2% (1)	12.7% (86)
>30	0.0% (0)	4.6% (31)
Smoking history
Daily Smoker	13.3% (6)	4.9% (33)	0.02
Occasional Smoker	71.1% (32)	85.1% (576)
Nonsmoker	15.6% (7)	9.9% (67)
Missing	0.0% (0)	0.10% (1)
Pack-years, mean (95% CI)	3.64 (1.58 to 5.70)	1.10 ( 0.81 to 1.39)	<0.001
History of pulmonary tuberculosis
Yes	31.1% (14)	7.7% (52)	<0.001
No	68.9% (31)	92.3% (625)
Missing	0.0% (0)	0.0% (0)
Biomass exposure
Wood	91.1% (41)	88.3% (598)	0.57
Other	8.9% (4)	11.7% (79)
Spirometry parameters
Pre-BD FEV1 (L), mean (95%CI)	1.78 (1.60 to 1.95)	2.41 (2.36 to 2.50)
Pre-BD FVC (L), mean (95%CI)	3.04 (2.80 to 3.30)	3.04 (2.99 to 3.10)
Pre-BD FEV1/FVC ratio, mean (95% CI)	0.58 (0.56 to 0.61)	0.79 (0.79 to 0.80)	<0.001
Post-BD FEV1 (L), mean (95% CI)	1.90 (1.72 to 2.08)	–
Post-BD FEV1/FVC ratio, mean (95% CI)	0.61 (0.59 to 0.63)	–
Bronchodilator reversibility			<0.001
Percentage change in FEV1, median (IQR)	6.93 (2.83 to 10.99)	8.05 (3.97 to 14.46)	0.24
Change in FEV1 volume, median (IQR)	120 (49.9 to 199.9)	155 (65 to 300)	0.24
COPD severity (GOLD classification)
Mild obstruction	37.8% (17)
Moderate Obstruction	48.9% (22)
Severe obstruction	13.3% (6)
Very severe Obstruction	0.0% (0)

Table 2. HIV-specific clinical characteristics stratified by COPD status among participants.

Characteristics	COPD-positive	COPD-negative	p-value
Duration since HIV diagnosis (years)			0.66
< 1	2.2% (1)	1.3% (9)
1–3.9	8.9% (4)	13.6% (92)
4–9.9	33.3% (15)	30.6% (207)
10+	20.0% (9)	14.8% (100)
Missing	35.6% (16)	39.7% (269)
Median duration since HIV diagnosis (IQR)	8.12 (6.03)	6.71 (5.97)	0.69
Antiretroviral therapy (ART)
Currently on ART	88.9% (40)	90.4% (612)	0.74
ART Duration (years)
< 1	11.1% (5)	10.2% (69)	0.83
1–3.9	22.2% (10)	29.5% (200)
4–9.9	42.2% (19)	39.4% (267)
10+	11.1% (5)	10.6% (72)
Missing	13.3% (6)	10.2% (69)
Median ART duration, years (IQR)	4.0(6.0)	4.0(5.0)	0.99
Viral Load (VL)
VL < 20 copies/mL	60.0% (27)	62.6% (424)	0.18
VL > 20 copies/mL	8.9% (4)	4.4% (30)
Missing viral loads	31.1% (14)	32.9% (223)
Median viral load/copies/mL (IQR)	0 (0)	0 (0)	0.34
Baseline CD4 + T cells (cells/mm^3)
<200	15.6% (7)	15.4% (104)	0.98
200–499	26.7% (12)	24.7% (167)
≥500	17.8% (8)	15.8% (107)
Missing	40.0% (18)	44.2% (299)
Median CD4 + T cells (cells/mm^3) IQR	322 (455)	337 (334)	0.72
Current CD4 + T cells (cells/mm^3)
<200	6.7% (3)	5.3% (36)
200–499	20.0% (9)	30.0% (203)
≥500	40.0% (18)	30.1% (204)
Missing	33.3% (15)	34.6% (234)
Median CD4 + T cells (cells/mm^3) IQR	579 (446)	472 (304)	0.18
History of recurrent bacterial pneumonia
Yes	6.7% (3)	4.3% (29)	0.45
History of candidiasis
Yes	4.4% (2)	4.6% (31)	0.97
History of PCP Pneumonia
Yes	0.0% (0)	0.0% (0)
History of Kaposi sarcoma
Yes	0.0% (0)	0.15% (1)	0.80
History of Pulmonary TB
Yes	31.1% (14)	7.9% (52)	<0.001

Table 3. Single variable and multivariable logistic regression results of the associations between participant characteristics and COPD.

Participant characteristics	Single variable		Multivariable
	OR (95% CI)	p-value	OR (95% CI)	p-value
Age (Reference 35–39 years)
40–44 years	0.48 (0.14, 0.71)	0.26	0.70 (0.08, 5.80)	0.75
45–54 years	1.87 (0.78, 0.46)	0.16	1.30 (0.25, 6.73)	0.75
55–80 years	1.61 (0.61, 4.27)	0.34	1.40 (0.26, 7.36)	0.69
Sex
Males vs. females	2.58 (1.38, 4.80)	0.003	1.99 (0.66, 6.02)	0.22
BMI (per 5 kg/m^2 increase)	0.22 (0.12, 0.41)	< 0.001	0.27 (0.08, 0.80)	0.02
Pack-years of smoking (per 20 pack-years)	4.49 (1.90, 10.6)	0.001	2.09 (0.40, 10.9)	0.38
Biomass exposure: wood vs. other fuel sources	1.35 (0.47, 3.88)	0.57	2.12 (0.21, 21.76)	0.53
HIV-specific characteristics
Viral load: detectable vs. undetectable	2.09 (0.69, 6.38)	0.19	2.18 (0.45, 10.6)	0.33
HIV duration since diagnosis (per 5 years)	1.09 (1.02, 1.16)	0.008	0.99 (0.89, 1.13)	0.99
Baseline CD4 count (per 1000 cells/mm^3)	1.34 (0.37, 4.91)	0.66	1.05 (0.14, 7.82)	0.96
Current CD4 count (per 1000 cells/mm^3)	3.14 (1.06, 9.24)	0.04	1.09 (0.17, 6.82)	0.93
Duration of ARV use (per 5 years)	1.19 (0.77, 1.83)	0.44	1.32 (0.61, 2.85)	0.48
Opportunistic infections
History of pulmonary tuberculosis vs. none	5.42 (2.71, 10.8)	<0.001	4.92 (1.71, 14.2)	0.003
History of recurrent pneumonia vs. none	0.62 (0.18, 2.14)	0.46	0.41 (0.03, 5.34)	0.49
History of candidiasis vs. none	1.03 (0.24, 4.46)	0.97	0.38 (0.03, 4.73)	0.45

Table 4. Multivariable linear regression analysis results for the association between participant characteristics and pre-bronchodilator lung function z-scores (FEV1, FVC and pre-FEV1/FVC ratio).

Characteristics	z-FEV1 (95% CI)	z-FVC (95% CI)	z-FEV1/FVC (95% CI)
Age (per 10 years)	0.018 (−0.15, 0.18)	0.12 (−0.049, 0.28)	−0.19 (−0.39, −0.0076)*
Male vs. Female	0.058 (−0.27, 0.38)	0.006 (−0.32, 0.33)	0.18 (−0.20, 0.55)
Previous tuberculosis vs. none	−0.61 (−1.04, −0.19)	−0.32 (−0.74, 0.11)	−0.71 (−1.21, −0.21)*
Body mass index (per 5kg/m^2)	0.13 (−0.068, 0.32)	0.059 (−0.135, 0.253)	0.12 (−0.10, 0.35)
Use of wood vs. other fuels	−0.74 (−0.54, 0.39)	0.042 (−0.43, 0.51)	−0.21 (−0.76, 0.33)
Household size (per 5 persons)	0.098 (−0.21, 0.41)	0.024 (−0.29, 0.34)	0.066 (−0.30, 0.43)
Pack-years of smoking (per 20 years)	−0.013 (−0.63, 0.60)	0.44 (−0.18, 1.058)	−0.93 (−1.65, −0.21)*
ART duration (per 5 years)	−0.057 (−0.27, 0.15)	0.0067 (−0.21, 0.22)	−0.15 (−0.39, 0.09)
HIV Duration (per 5 years)	−0.067 (−0.11, −0.024)	−0.064 (−0.11, −0.021)	−0.18 (−0.07, 0.031)
Baseline CD4 count (per 1000 cells/mm^3)	0.084 (−0.45, 0.61)	0.068 (−0.46, 0.59)	0.006 (−0.61, 0.62)
Current CD4 count (per 1000 cells/mm^3)	0.18 (−0.36, 0.72)	0.14 (−0.41, 0.68)	0.101 (−0.53, 0.73)
Viral load: detectable vs. undetectable	−0.37 (−0.93, 0.18)	−0.24 (−0.80, 0.32)	−0.49 (−1.13, 0.16)

Multivariable linear regression analysis included all variables shown in this table

Table 5. Respiratory symptom and quality of life scores across study participants stratified by COPD.

Characteristics	COPD-positive N = 45	COPD-negative N = 677	p-value
Cough over the past 3 months			<0.001
Most days a week	13.3% (6)	0.00% (0)
Several days a week	13.3% (6)	0.15% (1)
Only with infection	20.0% (9)	5.76% (39)
Not at all	53.3% (24)	94.09% (637)
Shortness of breath over the past 3 months			<0.001
Most days a week	17.8% (8)	0.00% (0)
Several days a week	17.8% (8)	0.15% (1)
Only with infection	13.3% (6)	0.59% (4)
Not at all	51.1% (23)	99.11% (671)
Wheeze over the past 3 months			<0.001
Most days a week	13.3% (6)	0.00% (0)
Several days a week	15.6% (7)	0.15% (1)
Only with infection	17.8% (8)	0.74% (5)
Not at all	53.3% (24)	99.1% (671)
Chest attacks over the past 3 months			<0.001
3 or more attacks a week	6.7% (3)	0.00% (0)
1–2 attacks a week	22.2% (10)	0.44% (3)
None	73.3% (33)	99.6% (674)
Phlegm over the past 3 months			0.010
Yes	24.4% (11)	1.03% (7)
No	75.6% (34)	98.80% (669)
Missing	0.00% (0)	(0.15%) 1
mMRC dyspnea scale
1	46.7% (21)	98.80% (669)	<0.001
2	27.8% (17)	7.40% (5)
3	11.1% (5)	0.00% (0)
4	4.44% (2)	0.30% (2)
Missing	0.00% (0)	0.15% (1)
Hospitalization in the last three months			<0.001
Yes	15.6% (7)	0.00% (0)
No	84.4% (38)	100.0% (677)
SGRQ scores
Total scores, mean (SD)	25.5 (21.3)	4.7 (11.2)	<0.001
Symptom scores, mean (SD)	34.6 (26.4)	7.1 (12.0)	<0.001
Activity scores, mean (SD)	34.1 (28.4)	5.4 (15.7)	<0.001
Impact scores, mean (SD)	18.6 (22.1)	3.3 (11.2)	<0.001
6-minute walk test
6MWT (m), mean (SD)	373 (76.8)