Respiratory disease trends in the Pulmonary Complications of HIV Infection Study cohort. Pulmonary Complications of HIV Infection Study Group.

Abstract

We examined trends in the incidence of specific respiratory disorders in a multicenter cohort with progressive human immunodeficiency virus (HIV) disease during a 5-yr period. Individuals with a wide range of HIV disease severity belonging to three transmission categories were evaluated at regular intervals and for episodic respiratory symptoms using standard diagnostic algorithms. Yearly incidence rates of respiratory diagnoses were assessed in the cohort as a whole and according to CD4 count or HIV transmission category. The most frequent respiratory disorders were upper respiratory tract infections, but the incidence of lower respiratory tract infections increased as CD4 counts declined. Specific lower respiratory infections followed distinctive patterns according to study-entry CD4 count and transmission category. Acute bronchitis was the predominant lower respiratory infection of cohort members with entry CD4 counts > or = 200 cells/mm3. In cohort members with entry CD4 counts of 200 to 499 cells/mm3, the incidence of bacterial and Pneumocystis carinii pneumonia each increased an average of 40% per year. In members with entry CD4 counts < 200 cells/mm3, acute bronchitis, bacterial pneumonia, and P. carinii pneumonia occurred at high rates without discernible time trends, despite chemoprophylaxis in more than 80% after Year 1, and the rate of other pulmonary opportunistic infections increased over time. Each year, injecting drug users had a higher incidence of bacterial pneumonia than did homosexual men. The yearly rate of tuberculosis was < 3 episodes/100 person-yr in each entry CD4 and HIV-transmission group. We conclude that the time trends of HIV-associated respiratory disorders are determined by HIV disease stage and influenced by transmission category. Whereas acute bronchitis is prevalent during all stages of HIV infection, incidence rates of bacterial pneumonia and P. carinii pneumonia rise continuously during progression to advanced disease. In advanced disease, the incidence of acute bronchitis, bacterial pneumonia and P. carinii pneumonia is high despite widespread chemoprophylaxis.

Clearance ofPneumocystis cariniiin Mice Is Dependent on B Cells But Not onP. carinii-Specific Antibody

“…It is widely known that CD4 ϩ T cells are required for clearance of P. carinii as CD4 ϩ T cell counts below 200/l of blood predisposes individuals to P. carinii pneumonia (PCP) 3 (5). It has also been shown in murine models of PCP that the absence of CD4 ϩ T cells results in the inability to mount an effective host response to P. carinii (6 -8).…”

Etiología de la neumonía en pacientes chilenos infectados por el virus de la inmunodeficiencia humana

“…La etiología más frecuente fue la infección por P. jiroveci seguida por S. pneumoniae. Estos resultados son muy similares a lo descrito con anterioridad a los inicios de la TARV 4 . Mycobacterium avium complex compartió el segundo lugar como agente etiológico por frecuencia (co-existiendo con otros agentes en 3/7 de los casos); no obstante, es infrecuente que este agente constituya una causa primaria de neumonía y habitualmente su aislamiento representa colonización o enfermedad diseminada 14,15 .…”

“…La tasa de neumonía por P. jiroveci en los pacientes con recuentos de linfocitos CD4 ≤ a 200 céls/mm 3 , sin uso de profi laxis, es de 8,08 casos por 100 personas-año 2 . La neumonía bacteriana se presenta con una incidencia entre 2,3 y 10,8 episodios por 100 personas-año en los pacientes infectados por VIH (comparado con 0,9 por 100 personasaño en individuos sanos) 3,4 . La broncoscopia con lavado bronco-alveolar (LBA) se considera el método estándar para el diagnóstico etiológico de la neumonía en pacientes infectados por VIH.…”

Pneumonia in HIV-Infected Patients

“…For the study population with CD4 levels <200 mm 3 , rates of bacterial pneumonia and PCP were elevated and the rate of other pulmonary OIs increased with time (27).…”