Prevalence of chronic obstructive pulmonary disease in patients diagnosed with HIV without prior antiretroviral treatment.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is the most prevalent respiratory problem in the world. Patients with human immunodeficiency virus (HIV) infection have a higher prevalence of smoking and recurrent lung infections and are at higher risk of COPD. OBJECTIVE: To determine the prevalence of COPD in HIV-diagnosed patients referred to an infectious diseases hospital. METHOD: Individuals with HIV infection without previous or ongoing antiretroviral treatment, with chronic respiratory symptoms, with or without a history of exposure for the development of COPD were included. Pre- and post-bronchodilation spirometry, high-resolution computed tomography, viral load determination and CD4 count were carried out. Spirometry measurements were compared with Wilcoxon's test. RESULTS: Sixty-six HIV-diagnosed patients, with a mean age of 31.5 years were included; 64 were males and two females. The prevalence of COPD was 7.6 %. The group with obstruction had a lower CD4 count (27.3 versus 225.9) and higher viral load (165,000 versus 57,722), in comparison with the group without obstruction. A positive correlation was observed between lower viral load and higher forced expiratory volume in 1 second/forced vital capacity ratio. CONCLUSION: HIV-positive patients with a lower CD4 count and a higher viral load show a decrease in spirometry values.

INTRODUCCIÓN: La enfermedad pulmonar obstructiva crónica (EPOC) es el problema respiratorio de mayor prevalencia en el mundo. Los pacientes con infección por virus de la inmunodeficiencia humana (VIH) tienen mayor prevalencia de tabaquismo e infecciones pulmonares recurrentes y mayor riesgo de EPOC. OBJETIVO: Determinar la prevalencia de la EPOC en pacientes con diagnóstico de VIH referidos a un hospital de infectología. MÉTODO: Se incluyeron individuos con infección por VIH sin tratamiento antirretroviral previo o actual, con sintomatología respiratoria crónica, con o sin antecedentes de exposición para desarrollar EPOC. Se realizó espirometría pre y posbroncodilatación, tomografía computarizada de alta resolución, determinación de carga viral y conteo de CD4. Las mediciones espirométricas se compararon con prueba de Wilcoxon. RESULTADOS: Se incluyeron 66 pacientes con diagnóstico de VIH, con edad de 31.5 años; 64 hombres y dos mujeres. La prevalencia de EPOC fue de 7.6 %. El grupo con obstrucción presentó menor conteo de CD4 (27.3 versus 225.9) y mayor carga viral (165 000 versus 57 722), en comparación con el grupo sin obstrucción. Se observó correlación positiva entre menor carga viral y mayor relación de volumen espiratorio forzado al primer segundo/capacidad vital forzada. CONCLUSIÓN: Los pacientes VIH-positivos con menor conteo de CD4 y mayor carga viral presentan disminución de los valores espirométricos.

Prevalence of chronic obstructive pulmonary disease in patients diagnosed with HIV without prior antiretroviral treatment / Prevalencia de enfermedad pulmonar obstructiva crónica en pacientes con diagnóstico de VIH sin tratamiento antirretroviral previo

Abstract Introduction: Chronic obstructive pulmonary disease (COPD) is the most prevalent respiratory problem in the world. Patients with human immunodeficiency virus (HIV) infection have a higher prevalence of smoking and recurrent lung infections and are at higher risk of COPD. Objective: To determine the prevalence of COPD in HIV-diagnosed patients referred to an infectious diseases hospital. Method: Individuals with HIV infection without previous or ongoing antiretroviral treatment, with chronic respiratory symptoms, with or without a history of exposure for the development of COPD were included. Pre- and post-bronchodilation spirometry, high-resolution computed tomography, viral load determination and CD4 count were carried out. Spirometry measurements were compared with Wilcoxon’s test. Results: Sixty-six HIV-diagnosed patients, with a mean age of 31.5 years were included; 64 were males and two females. The prevalence of COPD was 7.6 %. The group with obstruction had a lower CD4 count (27.3 versus 225.9) and higher viral load (165,000 versus 57,722), in comparison with the group without obstruction. A positive correlation was observed between lower viral load and higher forced expiratory volume in 1 second/forced vital capacity ratio. Conclusion: HIV-positive patients with a lower CD4 count and a higher viral load show a decrease in spirometry values.

Resumen Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) es el problema respiratorio de mayor prevalencia en el mundo. Los pacientes con infección por virus de la inmunodeficiencia humana (VIH) tienen mayor prevalencia de tabaquismo e infecciones pulmonares recurrentes y mayor riesgo de EPOC. Objetivo: Determinar la prevalencia de la EPOC en pacientes con diagnóstico de VIH referidos a un hospital de infectología. Método: Se incluyeron individuos con infección por VIH sin tratamiento antirretroviral previo o actual, con sintomatología respiratoria crónica, con o sin antecedentes de exposición para desarrollar EPOC. Se realizó espirometría pre y posbroncodilatación, tomografía computarizada de alta resolución, determinación de carga viral y conteo de CD4. Las mediciones espirométricas se compararon con prueba de Wilcoxon. Resultados: Se incluyeron 66 pacientes con diagnóstico de VIH, con edad de 31.5 años; 64 hombres y dos mujeres. La prevalencia de EPOC fue de 7.6 %. El grupo con obstrucción presentó menor conteo de CD4 (27.3 versus 225.9) y mayor carga viral (165 000 versus 57 722), en comparación con el grupo sin obstrucción. Se observó correlación positiva entre menor carga viral y mayor relación de volumen espiratorio forzado al primer segundo/capacidad vital forzada. Conclusión: Los pacientes VIH-positivos con menor conteo de CD4 y mayor carga viral presentan disminución de los valores espirométricos.

Development and validation of a questionnaire to identify patients with sleep apnea in Mexican population: Mexican questionnaire to identify sleep apnea.

PURPOSE: To develop and validate a questionnaire to identify patients with obstructive sleep apnea (OSA) in Mexican population. METHODS: We performed a cross-sectional study to develop and validate an instrument in Spanish language, consistent in an 18-item questionnaire. We enrolled patients seen from July 2008 to August 2009. We evaluated the internal consistency with the Kuder Richardson coefficient, a value greater than 0.70 was considered a good index correlation. Sensitivity, specificity, and positive and negative predictive factor was obtained with standard methods by comparison with polysomnographic results. Validity of Mexican questionnaire at baseline and follow-up was assessed using Pearson correlations coefficient. RESULTS: We enrolled 100 patients. The initial pool comprised 25 items, four items were considered confusing and they were omitted; then, a preliminary questionnaire comprising 21 items was obtained, and three items were removed by presenting a response rate lesser than 90%, yielding a total of 18 items for the final questionnaire. This evaluation was performed stratifying in groups related to severity of illness. Snoring was the question with the greatest sensitivity to detect OSA; and obesity class I was the criteria with greatest specificity to detect OSA. CONCLUSION: The screening tool proposed in this study has the advantages of being quick, inexpensive, easy to apply and reproducible, and the result has reliability with acceptable sensitivity; this is a symptom-based questionnaire with good predictive ability and it will avoid unnecessary sleep studies in the subjects who are not at high risk for having OSA.

[A H1N1 influenza infection in pregnant patients]. / Infección por virus influenza A H1N1 en pacientes embarazadas.

BACKGROUND: Despite the severity of infection with influenza virus, little has been reported about its presence in pregnant women. OBJECTIVE: To communicate our experience on influenza virus H1N1 in pregnant women. METHODS: We conducted a retrospective cohort study on 16 hospitalized patients with diagnosis of pregnancy and probable or confirmed case of infection with H1N1 influenza virus. SUSPECTED CASE: Sudden onset of respiratory infectious process, in 2009, in Mexico City. All cases underwent the fast detection test and subsequently confirmation by PCR test. Discharge criteria: clinical improvement, PaO(2) above 60 mm Hg and absence of bilateral consolidation on chest radiographs. Severity criteria: type I respiratory failure (PaO(2) < 50 mm Hg) who required mechanical ventilatory support, radiographic pattern compatible with multisegmental pneumonia and PaO(2)/FiO(2) < 200 mm Hg. RESULTS: The pregnant patient mortality was 4.25%. The average age was 25.8 years, with 24.13 weeks of gestation with 5.6 days average of hospital stay. The main co-morbidity was obesity. CONCLUSIONS: The fatal cases were those with longer time of evolution and late diagnosis.