Purpose of review
Human immunodeficiency virus (
HIV) is now managed as a chronic disease. Non-infectious pulmonary conditions have replaced infection as the biggest threat to lung health, particularly as
HIV cohorts age, but there is no consensus on how best to maintain long-term lung health. We review the epidemiology and pathogenesis of
chronic obstructive pulmonary disease (COPD),
pulmonary arterial hypertension (PAH), and
lung cancer in
HIV-seropositive individuals.
Recent findings
Diagnoses of COPD are now up to 50% more prevalent in
HIV-seropositive individuals than
HIV-uninfected controls, and prospective pulmonary function studies find significant impairment in 7% to more than 50% of
HIV-seropositive individuals. The prevalence of
HIV–PAH is 0.2–0.5%, and
lung cancer is two to three times more prevalent in
HIV-seropositive individuals. Although host factors such as age and smoking have a role,
HIV is an independent contributor to the pathogenesis of COPD, PAH, and
lung cancer. Chronic inflammation, immune senescence, oxidative stress, and direct effects of viral proteins are all potential pathogenetic mechanisms. Despite their prevalence, non-infectious lung diseases remain underrecognized and evidence for effective screening strategies in
HIV-seropositive individuals is limited.
Summary
COPD, PAH, and
lung cancer are a growing threat to lung health in the highly active antiretroviral therapy era necessitating early recognition.
