Clinical approach to HIV-associated pulmonary disease

Abstract

Pulmonary disease associated with HIV infection remains prevalent despite dramatic advances in HIV management. The spectrum of lung disease in the HIV-infected patient is broad, including infectious etiologies such as bacterial, mycobacterial, fungal, viral and protozoal, and noninfectious etiologies including neoplasm and chronic lung disease such as chronic obstructive pulmonary disease (COPD). Although the incidence of HIV-associated opportunistic pneumonia has decreased substantially with combined antiretroviral therapy (CART), bacterial pneumonia, Pneumocystis pneumonia and tuberculosis remain among the most common causes of morbidity and mortality among HIV-infected patients worldwide. As HIV-infected patients live longer, new associations of HIV with noninfectious pulmonary disease such as COPD, lung cancer and pulmonary arterial hypertension are being recognized. Characteristic findings on history and physical exam can be helpful in narrowing the broad differential diagnosis in the HIV patient presenting with respiratory symptoms. Further methodical evaluation with specific labs, chest imaging, sputum, and more invasive diagnostic approaches such as bronchoscopy can greatly aid in establishing the correct diagnosis. Clinical features of the three most common HIV-associated lung diseases-bacterial pneumonia, Pneumocystis pneumonia and tuberculosis-are discussed in detail. Copyright © 2010 by Lippincott Williams & Wilkins.