Prevalence and Determinants of Chronic Obstructive Pulmonary Disease (COPD) in HIV+ Patients
Condition: HIV Infections; COPD
MeSH terms: HIV Infections
Study type: Observational

Summary: 
      The prevalence of COPD in HIV+ and AIDS patients is unknown. The pathophysiology of HIV
      infection and COPD might be of interest to both conditions. The research hypotheses of this
      study are:

      In patients with HIV infection living in the Autonomous Community of the Balearic Islands
      (CAIB):

        1. The Prevalence of airflow obstruction in patients with HIV infection is higher than in
           the general population.

        2. In these patients, the prevalence of emphysema detected by HRCT is common (greater than
           or equal to 15%)

        3. DLCO measurement is a good marker for the presence of emphysema on CT

        4. The inflammatory response is different from that seen in patients with COPD and / or
           emphysema without HIV infection
    

Detailed description: 
      Objectives

      Main objective To determine the prevalence of COPD

      Secondary objectives

        1. To determine the prevalence (and severity) of emphysema (HRCT)

        2. To Identify risk factors associated with the development of COPD and / or emphysema

        3. To analyze the predictive value of measuring DLCO as a marker of emphysema by HRCT

        4. To determine the prevalence of lung function abnormalities deeming specific drug
           treatment (bronchodilators, inhaled corticosteroids) in the absence of clinical symptoms

        5. To compare the pattern of inflammatory response in patients with COPD and / or
           emphysema, with and without HIV infection

      Methodology:

      Cross-sectional, descriptive, study of up to 350 patients with HIV infection.

      All the patients will be be assessed with:

        1. an standardized clinical questionnaire

        2. full lung function tests

        3. high resolution CT scan

        4. induced sputum for bacterial culture, P. jiroveci, proinflamatory citokines (cytokines
           array)

        5. blood analysis: hemogram; basic biochemistry; HIV predictors; autoantibodies;
           proinflammatory citokines (ultrasensitive ELISA); C reactive protein (ultrasensitive
           nephelometry)

        6. exhaled gases (NO and CO)

      Statistical analysis:

      Description of the univariate distribution of the categorical or ordinal variables will be
      realized with a table of frequencies, and in quantitative variables by means of measures of
      central tendency (mean or median) and dispersion (standard deviation or 95 % confidence
      intervals). Depending on the normality of the distribution of variables, any comparisons will
      be assessed by means of parametric tests (T test; Chi2) or non parametric tests (Mann
      Whitney). To explore relationships between the variables of study, Kolgomorov-Smirnov for the
      comparison of groups and analysis of regression bivariate, and multivariate (logistic
      regression), will be conducted.
    

Observational model: Case-Only
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        Patients will be recruited from the HIV outpatient consultation of the Internal Medicine
        Department of Hospital Universitario Son Dureta (HUSD), in Mallorca, Spain. The HUSD is the
        tertiary, reference hospital in the CAIB.
      
Keywords: HIV+; COPD; emphysema