A COPD Case-Finding Program in a Large Cohort of HIV-Infected Persons

BACKGROUND: COPD screening guidelines in patients with HIV are lacking, and data about its under-diagnosis are still limited. This study aimed to determinate the feasibility of a case-finding program and the prevalence of COPD under-diagnosis in a large cohort of HIV-infected subjects. METHODS: All out-patients attending their routine visit for HIV monitoring at Spedali Civili General Hospital in Brescia, Italy, from February 2015 to January 2016, were enrolled. The case-finding program was structured in three steps: questionnaire administration, pre-bronchodilator spirometry testing measured with a portable spirometer, and post-bronchodilator diagnostic spirometry during a pulmonology appointment. RESULTS: A total of 1,463 subjects were included; the average age was 46.2 +/- 10.3 y. Two hundred eighty-two subjects had a positive questionnaire; 190 completed portable spirometry, and approximately 34% (65 of 190 subjects) reported respiratory impairment; of these 65 subjects, 33 completed diagnostic spirometry, and 66.7% (22 of 33) showed evidence of COPD, including 2 subjects with severe airway obstruction (GOLD stage 3, according to the Global Initiative for Chronic Obstructive Lung Disease). High dropout rates were observed in our program. Individuals with COPD exacerbations showed lower CD4+ cell counts at screening compared to those without acute worsening of symptoms (534 cells/mm(3) for subjects with GOLD 1 exacerbations and 495 cells/mm(3) for subjects with GOLD 2 exacerbations vs 781 cells/mm(3) for those without acute worsening of symptoms). The positive predictive value of the COPD screening questionnaire and portable spirometry was 33.8%. CONCLUSIONS: COPD may be under-diagnosed in HIV-infected people, and case-finding programs are an urgent issue to address as part of routine practice in these individuals.