Key Slides on Suspected COPD in an Older Man

With HIV

Supported by an educational grant from Gilead Sciences, Inc.;

Merck Sharp & Dohme Corp.; and ViiV Healthcare
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Faculty
Joseph J. Eron, Jr., MD
Professor of Medicine and Epidemiology
University of North Carolina
School of Medicine
Director, AIDS Clinical Trials Unit
University of North Carolina
Chapel Hill, North Carolina
Joseph J. Eron, Jr., MD, has disclosed that he has received consulting fees from
Gilead Sciences, Janssen, Merck, and ViiV and funds for research support from
Gilead Sciences, Janssen, and ViiV.
Patient Case 2: Aging Patient With HIV and COPD
 66-yr-old Latino man diagnosed Parameter at Current
Value
Presentation
with HIV in 2004
CD4+ cell count, cells/mm3 490
 Originally treated with EFV + HIV-1 RNA, copies/mL < 40
FTC/TDF HIV-1 genotype K103N, M184V
BMI 28
‒ Poorly adherent and rebounded CBC Normal
with resistance Metabolic panel Normal
HBV Immune
 Treated with DRV/RTV and HCV Negative
2 NRTIs with good adherence
 Currently on DRV/COBI/TAF/FTC

Slide credit: clinicaloptions.com

 Lung-HIV Consortium: Spirometric Abnormalities
Common in HIV
 Cross-sectional analysis of data Spirometric Abnormalities
from an observational cohort of
PWH from 9 US cities (N = 908) 10%

‒ Spirometry testing
‒ Questionnaires
27%
 Abnormal spirometry pattern was 63%
independently associated with age,
smoking status and intensity,
history of Pneumocystis infection,
asthma, and the presence of
respiratory symptoms
Normal Obstructed Restricted
Drummond. AIDS. 2016;29:1691. Slide credit: clinicaloptions.com
 INSIGHT-START Trial: Pulmonary Substudy
 Cross-sectional analysis of Patient Group COPD Prevalence (%)
treatment-naive PWH from Total patients 6.8
20 countries (N = 1026) Smoking status
 Current 11.7
‒ Median age: 36 yrs  Former 2.8
 Never 5.3
‒ 29% female
Age, yrs
3.9
‒ Median CD4+ count:  25-30 6.7
648 cells/mm3  31-36 7.6
 37-44 9.1
 > 44
‒ 28% current smokers
‒ 61% never smokers

Kunisaki. HIV Med.2015;16:119.

Kunisaki et al. HIV Slide
Med, credit:
2015. clinicaloptions.com
 DHHS: What About Corticosteroids and PIs?

Corticosteroid(s) Route Coadministration

With PIs
Beclomethasone Inhaled or intranasal
Budesonide, ciclesonide, fluticasone, mometasone Inhaled or intranasal
Betamethasone, budesonide Systemic
Dexamethasone Systemic
Prednisone, prednisolone Systemic
Betamethasone, methylprednisolone, triamcinolone Local injections

No dose adjustment necessary

Potential interaction that may require monitoring or regimen alteration
Do not coadminister

DHHS Guidelines. December 2019. Slide credit: clinicaloptions.com

 Lung Cancer in PWH
Cancer Incidence in Medicare
 Higher prevalence of smoking Enrollees With HIV ≥ 65 Yrs of Age[5]
compared with general
Total Cancer
population[1]
Lung
 HIV may be an independent risk Prostate
factor for lung cancer[1] Colorectum
Non-Hodgkin Lymphoma
 Compared with general Anus
population: Bladder
Liver
‒ Diagnosed at an earlier age[2,3] Breast
‒ Higher risk with a lower Kidney
cumulative pack-yr history[4] Melanoma
0 2 4 6 8 10 12
‒ Worse survival [1]
5-Yr Cumulative Incidence (%)
1. Sigel. BR J Cancer. 2013;109:1974 2. D’Jaen. Clin Lung Cancer. 2010;11:396. 3. Shiels. Clin
Infect Dis. 2017;64:468. 4. Kirk. Clin Infect Dis. 2007;45:103. 5. Yanik. AIDS. 2016;30:1663. Slide credit: clinicaloptions.com
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