HIV-related lung disorders

Abstract

Highly active antiretroviral therapy (HAART) has dramatically altered the spectrum of morbidity and mortality in HIV-infected patients. This has been attributed to improvements in the lung microenvironment leading to enhanced pulmonary immunity, either by preventing the progressive loss of immune function or by actually promoting immune restoration. However, these changes have been accompanied by the recognition of new pulmonary complications in HIV-infected subjects, especially those associated with immune reconstitution. In this review we will describe how HIV infection alters the normal pulmonary environment, highlight the effect of HAART on these perturbations, and discuss potential complications of HAART in the lung, focusing on the pulmonary immune reconstitution inflammatory syndrome.

Small Ruminant Lentiviruses and Human Immunodeficiency Virus: Cousins that Take a Long View

“…The source of antigen in IRIS may be of infectious or non-infectious origin. HIV proteins have not been excluded as targets in IRIS, though the low HIV levels observed in the alveolar space following HAART argues against this possibility [219]. However, cases of LIP and IP following HAART have been described as part of IRIS where no obvious infectious agent was found [220,221].…”

“…Similarly, in patients with LIP, HAART induces clinical improvement accompanied by a large reduction in virus load [218]. However, HAART is associated with new pulmonary complications such as immune reconstitution inflammatory syndrome (IRIS) and chronic obstructive pulmonary disease in some patients [219]. IRIS in particular is observed in up to 25% of patients.…”

Effect of Advanced HIV Infection on the Respiratory Microbiome

“…Numerous studies have demonstrated persistence of chronic lung inflammation even in subjects infected with HIV on HAART (32)(33)(34). It is tempting to speculate that this chronic inflammation may contribute to lung complications seen in the HAART era, which have moved away from classic opportunistic infections toward more chronic lung diseases, such as chronic obstructive pulmonary disease, pulmonary hypertension, and lung cancer (35).…”

HIV Infection and Risk for Incident Pulmonary Diseases in the Combination Antiretroviral Therapy Era

“…Continuous ART is associated with a decreased risk overall of AIDS and non-AIDS events (37), and ART has been suggested to have a protective effect on pulmonary function (38). Within the alveolar space, ART also decreases pulmonary HIV viral load and decreases nonspecific pulmonary inflammation (39,40). However, current data on the impact of ART on lung function and chronic pulmonary disease are conflicting, because another study has found that airflow obstruction was more likely in patients on ART (41).…”