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Diagnostic performance of clinical characteristics to detect airflow limitation in people living with HIV and in uninfected controls
Author(s) -
Ronit A,
Benfield T,
Mocroft A,
Gerstoft J,
Nordestgaard BG,
Vestbo J,
Nielsen SD
Publication year - 2018
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12669
Subject(s) - medicine , confidence interval , spirometry , copd , population , vital capacity , sputum , lung function , asthma , environmental health , lung , pathology , diffusing capacity , tuberculosis
Objectives Chronic obstructive pulmonary disease ( COPD ) is underdiagnosed in the general population and possibly also in people living with HIV ( PLWH ). We evaluated the diagnostic performance of symptoms and risk factors for assessment of airflow limitation in PLWH and in uninfected controls. Methods Spirometry was performed in the Copenhagen Comorbidity in HIV Infection ( COCOMO ) study and Copenhagen General Population Study ( CGPS ), and airflow limitation was defined by forced expiratory volume in 1 s/forced vital capacity < lower limit of normal. We calculated the sensitivity, specificity, predictive values and area under the curve ( AUC ) of symptoms and risk factors for assessment of airflow limitation in PLWH and uninfected controls. Results A total of 1083 PLWH and 12 074 uninfected controls were included in the study. The sensitivity for sputum, chronic cough, breathlessness, wheezing, current and cumulative smoking and self‐reported COPD was higher, but the specificity lower, in PLWH than in uninfected controls. The negative and positive predictive values were largely similar between the groups. The AUC s were similar or slightly higher in PLWH and highest for > 20 pack‐years smoked [0.65; 95% confidence interval ( CI ) 0.58–0.72] and wheezing (0.64; 95% CI 0.57–0.71). A summed score for five variables was associated with slightly higher AUC in PLWH compared with uninfected controls [0.71 (95% CI 0.63–0.79) versus 0.65 (95% CI 0.63–0.68), respectively; P = 0.06]. Conclusions Clinical variables were relatively poor discriminators of airflow limitation in PLWH and uninfected controls. Active COPD case finding by screening for symptoms and relevant exposures, as recommended in the general population, is likely to yield similar diagnostic power in PLWH .