HIV-associated COPD : an exploration of risk factors and impacts

• Main Author: Liu, Joseph Chao-Yu
• Language: English
• Published: University of British Columbia 2014
• Online Access: http://hdl.handle.net/2429/47012

With recent advances in highly active antiretroviral therapy (HAART) and HIV-patient care, the longevity of individuals living with human immunodeficiency virus (HIV) infection has drastically increased. However, long term complications like chronic obstructive pulmonary disease (COPD) are synchronously more prevalent among this population. The fact that clinical manifestations of COPD develop in young HIV-infected individuals (20 to 50 years of age) compared older uninfected smokers (>50 years of age) suggests HIV-associated COPD may reflect a state of accelerated aging. In this thesis, we presented the clinical and HIV-related variables associated with telomere length, a measure of cellular age, in an HIV-infected cohort and explored the variables that determine poorer respiratory related health quality in this cohort. By using a novel technique to determine telomere length in peripheral leukocytes of HIV-infected and uninfected male subjects, we found that: firstly, telomere lengths were significantly shorter with HIV-infection even after adjusting for age, BMI, and smoking; secondly, telomere lengths were significantly and independently associated with age, FEV1(% of predicted), and soluble cluster of differentiation (sCD14); and thirdly, shorter telomere lengths were seen with worse emphysema scores as enumerated by computed tomography (CT) scans. Furthermore, the advantage of this new telomere length assay allowed us to determine that participants in our study demonstrated a “telomere age” roughly 40 years older than their biologic age, yet their respective slopes of decline with age remained parallel, when compared to an uninfected cohort. The St. George’s Respiratory Questionnaire was used to assess the influence of respiratory symptoms on a patient’s self-perceived health, social, and psychological status. Strikingly, we found HIV-infected patients are plagued with considerable respiratory limitations when compared to uninfected and even COPD counterparts. Also, we found that FEV1%pred, CD4 cell count, interleukin-6 (IL-6), but not telomere length were associated with worse respiratory health.