Pulmonary infections in the HIV-infected patient in the era of highly active antiretroviral therapy: An update

Abstract

The highly active antiretroviral therapy (HAART) era began in 1996 when the combination of multiple antiretroviral agents was found to improve outcomes in HIV-infected patients. HAART has made a tremendous impact on the progression of HIV and on the morbidity and mortality associated with its opportunistic infections. HIV-positive patients who respond to HAART have a decreased incidence of opportunistic infections. Studies have documented close to a 50% decline in the incidence of pneumocystis pneumonia and bacterial pneumonia with the use of antiretroviral therapy. Primary and secondary prophylaxis for pneumocystis pneumonia can be discontinued in patients who show a sustained response to antiretroviral therapy. Unique to the HAART era, immune reconstitution syndrome is characterized by a paradoxical deterioration of a preexisting infection that is temporally related to the recovery of the immune system. Recently, more and more patients are being admitted for non-AIDS related illnesses in the HAART era.

Pulmonary infections in HIV-infected patients: an update in the 21st century

“…Data regarding the effectiveness of pneumococcal vaccination in HIV-positive patients are still controversial [12,13]. A clinical trial of pneumococcal polysaccharide vaccine paradoxically determined that an increased risk of pneumonia was associated with vaccination [40,41].…”

“…It is usually performed by bronchoalveolar lavage (BAL), induced sputum and, on rare occasions, lung biopsy [13]. Bronchoscopy with BAL is the preferred diagnostic procedure for PCP, with reported sensitivity of 90-98%.…”

“…Lower respiratory tract infections are 25-fold more common in patients with HIV than in the general community, occurring in up to 90 cases per 1,000 person-yrs [12]. Currently, pulmonary infections, not only AIDS-related opportunistic infections, remain a leading cause of morbidity and mortality and one of the most frequent causes of hospital admission in HIV infected people worldwide [13]. An incidence of 20-25 episodes per 100 hospital admissions per year has been observed [14,15].…”

Bacterial and fungal agents causing lower respiratory tract infections in patients with human immunodeficiency virus infection

“…4 Pulmonary infections remain a leading cause of morbidity and mortality and one of the most frequent cause of hospital admissions in HIV-infected cases worldwide with 20 -25 episodes per 100 hospital admissions per year. 5,6 There are major differences in the spectrum of pathogens of respiratory infections in India and the west. However, the relative importance of infections and the pathogens differ from region to region.…”

Pulmonary Infiltrates in HIV Patients in the Highly Active Antiretroviral Therapy Era

“…Despite these gains, pulmonary disease remains a leading cause of morbidity and mortality. 3 From the first descriptions of HIV/AIDS, the respiratory tract has been the site most frequently affected by the disease. 4 -6 Up to 70% of HIV patients have a pulmonary complication during the evolution of the disease, mainly of infectious etiology.…”