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Ken Kunisaki, M.D., M.S.

Chronic obstructive pulmonary disease (COPD) in a large international cohort of HIV-infected adults with CD4+ > 500 cells/mm 3. Ken Kunisaki, M.D., M.S.

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Ken Kunisaki, M.D., M.S.

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  1. Chronic obstructive pulmonary disease (COPD)in a large international cohort of HIV-infected adults with CD4+ >500 cells/mm3 Ken Kunisaki, M.D., M.S. Co-authors: Dennis Niewoehner, Gary Collins, Daniel Nixon, Ellen Tedaldi, Christopher Akolo, Cissy Kityo, HartwigKlinker, Alberto La Rosa, John Connett, and the INSIGHT START Study Team

  2. Conflicts of Interest • I have no conflicts of interest to report

  3. COPD: Chronic Obstructive Pulmonary Disease Niewoehner DE. N Engl J Med 2010;362:1407

  4. Global Burden of Disease Study. Lancet 2012;380:2095-2128

  5. HIV Increases COPD Risk • Main COPD risk factor is cigarette smoking • HIV is also a COPD risk factor Kuhlman 1989, Gelman 1999, Diaz 2000, Morris 2000, Crothers 2006, Crothers 2011, Drummond 2011, Drummond 2013, Nakamura 2014 • COPD prevalence in PLWH varies from 3%-23% George 2009, Cui 2010, Gingo 2010, Hirani 2011, Kristoffersen 2012, Drummond 2013, Madeddu 2013, Samperiz 2013, Nakamura 2014 • We aimed to assess COPD prevalence in a large, multi-site, multi-national sample of PLWH.

  6. START Pulmonary Substudy • Strategic Timing of Antiretroviral Treatment (START) Trial • Infected with HIV-1, naïve to ART • CD4 >500 cells/mm3 • Age ≥18 • Not currently pregnant • Pulmonary Substudy • Age ≥25 • No asthma medication use • No contraindications to post-bronchodilator spirometry • Unstable heart disease, surgery within 6 months, respiratory illness within 6 weeks, allergy to albuterol/salbutamol

  7. Methods • Post-bronchodilator spirometry • FEV1 • FVC • FEV1/FVC ratio FEV1/FVC <5th %tile

  8. Enrollment

  9. Demographics

  10. Regional Demographics

  11. COPD Prevalence Overall COPD prevalence 6.8% (95% CI: 5.3% - 8.5%)

  12. COPD Prevalence – Region

  13. COPD by Age & Smoking

  14. Spirometry Regression Analysis • Multivariate linear regression • Lower FEV1/FVC ratio associated with: • Older age (p<0.0001) • Increased smoking pack-years (p<0.0001) • Differed by region (p=0.01)

  15. Conclusions • Successfully enrolled 1,026 adult PLWH (CD4>500, naïve to ART) from 80 sites and 20 countries • COPD: • is not uncommon (6.8%) • appears to relate strongest to smoking and aging • varies by global region

  16. Clinical Implications • Smoking cessation • COPD as PLWH age • Need to familiarize PLWH providers with tools for COPD screening, diagnosis, management

  17. Future Directions • Prospective data • Kristoffersen 2012: n=63 (Denmark); 9.5% COPD prevalence at baseline; 19.0% at 4.4 year follow-up. • ART effect on lung function decline • Conflicting data on ART as COPD risk factor • Randomized allocation will address this

  18. Acknowledgements Thank you to each of the 1,026 substudy participants • 80 sites around the world • University of Minnesota (USA) • Gary Collins, Mollie Roediger-Poelhman, Carol Miller, John Connett, Dennis Niewoehner • The Kirby Institute (Australia) • Cate Carey, Simone Jacoby, Vida Shahamat, Megan Clewett • Copenhagen HIV Programme (Denmark) • Bitten Aagaard, Mary Pearson, Per Jansson, DaniellaGey • MRC Clinical Trials Unit (UK) • NafisahBraimah, Fleur Hudson, Michelle Gabriel, Nicki Doyle • CPCRA (USA) • Betsy Finley, Adriana Sanchez • Ellen Tedaldi (Temple Univ, USA) • Daniel Nixon (VCU, USA) • Jorgen Vestbo (Manchester Univ, UK) Study funded by R01 HL096453

  19. Multivariate Linear Regression

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