Pulmonary complications of HIV infection

Abstract

The AIDS epidemic has had a devastating global impact in the last two decades; although prevalence rates are low in Asia and the Pacific, their enormous population is associated with an estimated 1 million people infected with HIV in 2006 alone. Survival from what had been a uniformly fatal illness has improved markedly with combination antiretroviral therapy and restoration of the immune system, but these treatments are expensive and difficult to distribute to the millions who need them around the world. In addition, millions more do not know they are infected with HIV until they develop an opportunistic infection. The lungs are the most frequent sites of these infections, and in different geographic regions, tuberculosis, bacterial pneumonia and Pneumocystis jiroveci are the dominant pathogens. The incidences of lung cancer and HIV-associated pulmonary arterial hypertension are also increasing in patients with HIV infection, and with the use of antiretrovirals, inflammatory disorders associated with immune restoration are being recognized.

A Multiplex Real-Time PCR Assay for Identification of Pneumocystis jirovecii, Histoplasma capsulatum, and Cryptococcus neoformans/Cryptococcus gattii in Samples from AIDS Patients with Opportunistic Pneumonia

“…In fact, almost 70% of people infected with HIV suffer at least one pulmonary complication during the course of the infection (2). Although in early HIV infection the agents that cause pneumonia are similar to those found in the general population, when the number of CD4 ϩ T cells decreases, opportunistic pneumonias are associated with high morbidity and mortality (3)(4)(5). Tuberculosis and Pneumocystis jirovecii pneumonia (PCP; the abbreviation PCP reflects the previous nomenclature for the Pneumocystis species causing opportunistic pneumonia in humans, P. carinii; P. jirovecii is now recognized as the species that infects humans) are the most commonly reported AIDS-defining illnesses (6).…”

Multiform spectrum of pulmonary disease in lethal HIV infection cases in Latvia (2012–2016)

“…Pre-ART (antiretroviral therapy) era studies, including autopsy-based, reported that CMV disease was recognized in endstage AIDS patients before death in up to 40% and at autopsy in up to 90% at that time [30]. Since the introduction of ART, CMV incidence and the related mortality among AIDS patients have declined.…”

“…In advanced stages of HIV course, cavitary TB is uncommon and lower-lobe infi ltrates or miliary dissemination as well as extrapulmonary TB usually occurs [6,15]. If extrapulmonary TB develops in immunocompetent individuals, no active pulmonary lesions are usually found at that time; however, in HIV/AIDS patients disseminated TB is characterized by simultaneous involvement of the lungs and other organs [16,30].…”

“…Some authors suggest that CMV infection accelerates AIDS progression [26]. Mostly CMV disease is a result of reactivation of latent infection due to the fact that 50%-90% of adult general population depending on the world region are seropositive, as CMV and HIV share transmission routes [26,30,36].…”

“…In the latter case, the lesions are miliary, bilateral, involving the pleura. Disseminated multi-organ disease, a result of vascular invasion, is uncommon but highly lethal [1,13,30].…”