Abstract
The advent of highly active antiretroviral therapy has significantly increased the longevity of people living with HIV infection. Consequently, the HIV patient population is maturing, and age-related diseases now have a much greater impact on their health and well-being than do HIV associated infections. Cigarette smoke exposure is highly prevalent in the HIV community and chronic smoke inhalation triggers the onset and progression of chronic obstructive pulmonary disease (COPD). Typically, COPD is an age-related disorder that only occurs after decades of smoke exposure. However, HIV infected patients exhibit heightened susceptibility to this disorder often developing this disease up to ten years earlier than smokers without HIV. COPD is a leading cause of death in the United States and worldwide, so it is important to decipher the causes of HIV-related respiratory disease. This review addresses the changing demographics of HIV infection in the post-HAART era and how these changes increase the importance of diseases like COPD. It also summarizes the evidence indicating that HIV is not merely a co-factor associated with smoking but rather a causal agent that independently promotes disease development. Lastly, we review the potential mechanisms by which the HIV virus and HIV medications alter lung biology to promote airflow and lung tissue destruction. Given the growing burden of COPD in people living with HIV, the medical community needs better treatment strategies to improve long term outcomes in this patient population. Thus, understanding how HIV infection fosters the onset of COPD is an urgent public health concern.
Keywords
COPD, airflow, lung, antiretroviral