Five years ago, after years of labored breathing, wheezing and coughing (with mucous), Mark Lewis learned that he had chronic obstructive pulmonary disease (COPD), which blocks the flow of air in the lungs. Forty-eight at the time, Lewis had been smoking for 34 years. Lewis, who lives in New Mexico, says, “[When I got the diagnosis] I wanted to kick myself in the pants. I thought, ‘This wouldn’t have happened if I hadn’t smoked.’ But it wasn’t as bad as when I was diagnosed with HIV [in 1985].”
COPD, an umbrella term, can include emphysema or chronic bronchitis, and Lewis’s symptoms were typical early signs. Over time, COPD may increase the risk of recurrent lung infections and can cause appetite and weight loss, muscle wasting, cardiovascular disease or low oxygen levels (possibly leading to pulmonary hypertension).
Long-term smoking—about 20 pack-years (a pack a day for two decades)—poses by far the greatest risk for COPD, and quitting can slow COPD progression. Lewis, who tried to quit many times before his COPD diagnosis, has now kicked the habit.
But even nonsmokers with HIV—those with no other known risk factors such as occupational exposure to inhaled toxins or smoked or injected drugs—get COPD more often than negative people. That’s what Katrina Crothers, MD, a researcher and pulmonologist at Yale School of Medicine, concluded from her recent study of 1,014 HIV-positive and 713 negative male military veterans. And unlike negative people, who generally develop COPD in their 50s or 60s, positive people are getting COPD at younger ages.
The study doesn’t show that HIV causes COPD, Crothers points out, nor does it explain the link between HIV and COPD. Lung tissue inflammation created by HIV may be one culprit. Another, she says, could be that HIV contributes to an accelerated aging of the lungs. (A recent Johns Hopkins School of Public Health study showed a similar but weaker correlation between lung cancer and HIV.)
Even a high CD4 count and undetectable viral load that can protect against some lung infections may not defend against HIV-related COPD. Lewis, for example, had an undetectable viral load and about 1,100 CD4s when his COPD was diagnosed.
While it’s not known whether HIV-positive women are similarly at higher risk for COPD, studies have shown women in general to be more susceptible. Because women’s lungs are often smaller than men’s, the same amount of exposure to cigarette smoke or other inhaled toxins may cause more damage in women. There are several COPD studies underway that include HIV-positive women, so this question may soon be answered.
Until we have more clarity, Crothers urges health care providers to view all people with HIV as a COPD high-risk group who could benefit from regular tests monitoring lung function.