Pulmonary Manifestations of HIV

Chronic immune activation and systemic inflammation causes increased Prevalence of lung disease in HIV
Noninfectious Respiratory Conditions with higher Prevalence in HIV (despite Antiretroviral therapy)
1. Obstructive Lung Disease (Asthma, COPD)
  1. Precaution: Protease Inhibitors have Drug Interactions with longterm Inhaled Corticosteroids
2. Pulmonary Hypertension
3. Interstitial Lung Disease
4. Lung Cancer
5. Recurrent respiratory infections
6. Tobacco Abuse is more common in HIV patients

Typical Bacterial Pneumonias are the most common Bacterial Pneumonias seen in HIV and AIDS patients
1. Pneumococcal Pneumonia
2. Haemophilus Influenzae
3. Staphylococcus Aureus
4. Pseudomonas Aeruginosa (less common)
Mycobacterium
1. Tuberculosis
  1. May occur at any CD4, but especially occurs in advanced HIV with CD4 < 500
  2. Suggestive findings include cavitary lesions, fever >7 days, weight loss
  3. More common with incarceration, Homelessness, congregate housing, travel to endemic regions
2. Mycobacterium Avium Complex or MAC (AIDS)
Parasitic
1. Toxoplasmosis
Viruses (CD4 <50)
1. Cytomegalovirus (CMV)
2. Herpes Simplex Virus (HSV)
Fungal (advanced HIV and AIDS)
1. CD4<200
  1. Pneumocystis jiroveci Pneumonia (PCP Pneumonia)
    1. Interstitial Infiltrates AND Thrush (Odds Ratio 11.8)
    2. Other predictive findings include exertional Dyspnea, inspiratory crackles, subacute disease course
2. CD4<50
3. Other less common endemic fungi (consider in those living in or traveling to endemic regions)
  1. Coccidioidomycosis
  2. Blastomycosis
Malignancy
1. Kaposi's Sarcoma
2. Non-Hodgkin's Lymphoma