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Objectives The aim of the study was to describe the prevalence and correlates of chronic obstructive pulmonary disease ( COPD) in a multicentre international cohort of persons living with HIV ( PLWH). Methods We performed a cross-sectional analysis of adult PLWH, naïve to HIV treatment, with baseline CD4 cell count > 500 cells/μL enrolled in the Pulmonary Substudy of the Strategic Timing of AntiRetroviral Treatment ( START) trial. We collected standardized, quality-controlled spirometry. COPD was defined as forced expiratory volume in 1 s:forced vital capacity ( FEV1: FVC) ratio less than the lower limit of normal. Results Among 1026 participants from 80 sites and 20 countries, the median age was 36 [interquartile range ( IQR) 30, 44] years, 29% were female, and the median time since HIV diagnosis was 1.2 ( IQR 0.4, 3.5) years. Baseline median CD4 cell count was 648 ( IQR 583, 767) cells/μL, median viral load was 4.2 ( IQR 3.5, 4.7) log10 HIV-1 RNA copies/mL, and 10% had a viral load ≤ 400 copies/mL despite lack of HIV treatment. Current/former/never smokers comprised 28%/11%/61% of the cohort, respectively. COPD was present in 6.8% of participants, and varied by age, smoking status and region. Forty-eight per cent of those with COPD reported lifelong nonsmoking. In multivariable regression, age and pack-years of smoking had the strongest associations with FEV1: FVC ratio ( P < 0.0001). There was a significant effect of region on FEV1: FVC ratio ( P = 0.010). Conclusions Our data suggest that, among PLWH who were naïve to HIV treatment and had CD4 cell counts > 500 cells/μL, smoking and age were important factors related to COPD. Smoking cessation should remain a high global priority for clinical care and research in PLWH. [ABSTRACT FROM AUTHOR]

This study examines the use of various direct observation therapy-HAART treatment support modalities in Jos, Nigeria. A 12-month observational study enrolling 175 antiretroviral naïve patients into four arms of direct observation therapy-HAART (highly active antiretroviral therapy); daily observed therapy (DOT), twice weekly observed therapy (TWOT), weekly observed therapy (WOT) and self-administered therapy (SAT), examined community treatment support using family and community members. Treatment outcomes were much better in the treatment-supported groups compared with the control self-therapy group. CD4 cell increases were 218/μL (DOT), 267/μL (TWOT), 205/μL (WOT) versus 224/μL (SAT), whereas plasma HIV-1 RNA reached undetectable levels (<400 copies/mL) in 91%, 88%, 84% versus 79% of patients in the DOT, TWOT, WOT versus SAT groups, respectively, at 48 weeks. We, therefore, strongly support the use of treatment support in our settings. [ABSTRACT FROM AUTHOR]