Spectrum of pulmonary diseases associated with the acquired immune deficiency syndrome

Increased incidence of asthma in HIV-infected children treated with highly active antiretroviral therapy in the National Institutes of Health Women and Infants Transmission Study

“…Our findings are in agreement with most studies of adult patients with HIV infection [5][6][7][8] but not other studies. 9,10 Most of these adult studies were performed in the pre-HAART era [6][7][8][9][10] and the timing of HIV infection (adults vs. infants) and immune ontogeny (developed vs. developing) most likely explains the lack of complete agreement. One clear example of the difference between pediatric adult HIV pathogenesis is the rapid rise and persistent (≥3 years) elevation in HIV RNA level (hundred thousand to million range) in newborns 26 compared to a much lower HIV viral set-point observed 6-8 weeks after infection in adults.…”

“…4 There are studies that document an increase in bronchial hyperresponsiveness and asthma in HIV-infected adults [5][6][7][8] , but other studies do not confirm these findings. 9,10 For example, Lin and Lazarus 7 made the seminal observation that a recent CD4 + T cell count of ≥200 cells/μL was significantly associated with current asthma (P=0.01). The weight of this evidence suggests that adults with HIV infection have an increased prevalence of asthma, but most of these studies took place in the pre-HAART era when the immunoreconstitution inflammatory syndrome 11 was unknown, and most studies did not stratify patients by their CD4 + T cell count.…”

Recent advances in the diagnosis, treatment, and prevention of Pneumocystis carinii pneumonia

“…However, because of the morbidity associated with the procedure, as well as the recently documented effectiveness of BAL in establishing a diagnosis in most cases, open-lung biopsy must now be considered a procedure of last resort to be used when other, less invasive methods have failed or are contraindicated. Improvements in fiber-optic bronschoscopy have allowed BAL, with or without transbronchial biopsy, to emerge as a leading diagnostic technique in the evaluation of pulmonary disease in both AIDS and non-AIDS patients (4,10,38). The presence of pneumocystis organisms in a BAL specimen from an untreated patient is highly suggestive of clinical infection and therefore almost always merits active therapy (30).…”

The status of CMV as a human pathogen

“…AIDS patients frequently have CMV detected in the lung by culture of BAL fluid but P. carinii is often found in the same specimen (Murray et al 1984;Stover et al 1985). Such patients frequently respond promptly to treatment with cotrimoxazole irrespective of whether or not CMV was co-infecting the lung.…”