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HIV Infection, Pulmonary Tuberculosis, and COPD in Rural Uganda: A Cross-Sectional Study

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Abstract

Purpose

HIV is associated with chronic obstructive pulmonary disease (COPD) in high resource settings. Similar relationships are less understood in low resource settings. We aimed to estimate the association between HIV infection, tuberculosis, and COPD in rural Uganda.

Methods

The Uganda Non-communicable Diseases and Aging Cohort study observes people 40 years and older living with HIV (PLWH) on antiretroviral therapy, and population-based HIV-uninfected controls in rural Uganda. Participants completed respiratory questionnaires and post-bronchodilator spirometry.

Results

Among 269 participants with spirometry, median age was 52 (IQR 48–55), 48% (n = 130) were ever-smokers, and few (3%, n = 9) reported a history of COPD or asthma. All participants with prior tuberculosis (7%, n = 18) were PLWH. Among 143 (53%) PLWH, median CD4 count was 477 cells/mm3 and 131 (92%) were virologically suppressed. FEV1 was lower among older individuals (− 0.5%pred/year, 95% CI 0.2–0.8, p < 0.01) and those with a history of tuberculosis (− 14.4%pred, 95% CI − 23.5 to − 5.3, p < 0.01). COPD was diagnosed in 9 (4%) participants, eight of whom (89%) were PLWH, six of whom (67%) had a history of tuberculosis, and all of whom (100%) were men. Among 287 participants with complete symptom questionnaires, respiratory symptoms were more likely among women (AOR 3.9, 95% CI 2.0–7.7, p < 0.001) and those in homes cooking with charcoal (AOR 3.2, 95% CI 1.4–7.4, p = 0.008).

Conclusion

In rural Uganda, COPD may be more prevalent among PLWH, men, and those with prior tuberculosis. Future research is needed to confirm these findings and evaluate their broader impacts on health.

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Acknowledgements

We thank the Uganda Non-communicable Diseases and Aging Cohort study participants who made this study possible by participating in this work; and Sheila Abaasabyoona, Zulaika Namboga, Doreen Kyomuhendo, Alan Babweteera, and members of the HopeNet Study team for research assistance. No endorsement of manuscript contents or conclusions should be inferred from these acknowledgements.

Funding

This study was funded by the U.S. National Institutes of Health R21HL124712, P30AI060354, P30ES000002, R24AG044325, R25TW009337, and Friends of a Healthy Uganda. The authors acknowledge the following additional sources of support: T32HL116275, K23MH096620, and K23MH099916. Travel support for study investigators was provided by the travel award programs of Massachusetts General Hospital Global Health and the Partners Center of Expertise in Global and Humanitarian Health. Biostatistical consultation was provided with support from Harvard Catalyst, the Harvard Clinical and Translational Science Center (UL1TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Harvard Catalyst, Harvard University, and its affiliated academic healthcare centers, or the National Institutes of Health.

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA

    Crystal M. North & David C. Christiani

  2. Harvard Medical School, Boston, MA, USA

    Crystal M. North, Edward T. Ryan, Alexander C. Tsai, David C. Christiani & Mark J. Siedner

  3. Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Crystal M. North, Joseph G. Allen & David C. Christiani

  4. Mbarara University of Science and Technology, Mbarara, Uganda

    Samson Okello, Ruth Sentongo, Bernard Kakuhikire & Mark J. Siedner

  5. Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA

    Edward T. Ryan & Mark J. Siedner

  6. Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Edward T. Ryan

  7. Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Alexander C. Tsai

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  1. Crystal M. North
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Correspondence to Crystal M. North.

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North, C.M., Allen, J.G., Okello, S. et al. HIV Infection, Pulmonary Tuberculosis, and COPD in Rural Uganda: A Cross-Sectional Study. Lung 196, 49–57 (2018). https://doi.org/10.1007/s00408-017-0080-8

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