Noninfectious Pulmonary Complications of HIV/AIDS

Georgette D Kanmogne

Disclosures

Curr Opin Pulm Med. 2005;11(3):208-212. 

In This Article

Abstract and Introduction

Purpose of Review: This article reviews recent findings on noninfectious pulmonary complications of HIV/AIDS, with a focus on HIV/AIDS-related lung malignancies and pulmonary hypertension, and discusses their incidence in the highly active antiretroviral therapy (HAART) era.
Recent Findings: Noninfectious pulmonary complications of HIV/AIDS are now recognized as important contributors to morbidity and mortality in HIV-infected patients. This is especially the case for HIV-related lung cancer and other non-AIDS-defining malignancies, which are now being diagnosed with increased frequency in HIV-infected patients. The incidence of Kaposi sarcoma and AIDS-related lymphoma has decreased in the HAART era, but compared with the general population, the risk of these malignancies and pulmonary hypertension is still very high in HIV-infected patients. Concurrent use of HAART and chemotherapy improves prognosis and survival of patients with AIDS-related lymphoma. For patients with HIV-related pulmonary hypertension, some studies show no beneficial effect of HAART whereas other reports show that HAART improves patient survival and response to antihypertensive treatment.
Summary: The beneficial effect of HAART and improved immune response on the treatment of Kaposi sarcoma and AIDS-related lymphoma suggests that HIV or viral-induced immunosuppression plays an important role in the development of these malignancies. Evidence from current studies suggests that HAART does not protect against HIV-related lung cancer. The full impact of HAART on HIV pulmonary hypertension remains to be determined.

Pulmonary complications of AIDS represent major causes of morbidity and mortality in HIV-infected patients, and despite the advent of highly active antiretroviral therapy (HAART), the lung continues to be the most frequently involved organ in AIDS autopsy cases.[1,2] Noninfectious pulmonary complications are common in HIV infection, including malignancies, pulmonary hypertension, and lymphoproliferative disorders. Kaposi sarcoma, non-Hodgkin lymphoma (NHL), and cervical cancer are considered AIDS-defining illness[3] but several studies show that other cancers such as Hodgkin lymphoma, lung, lip, brain, testicular, colorectal, and liver cancers also occur in excess in HIV-infected patients.[4,5,6,7,8,9,10,11,12,13*,14,15*,16,17,18] Chronic pulmonary complications like pulmonary hypertension, lymphocytic interstitial pneumonitis, nonspecific interstitial pneumonitis, and lymphocytic alveolitis also occur with increased frequency in HIV infection.[19]

The use of HAART is associated with decrease in the incidence and mortality due to HIV-related infectious pulmonary complications and some AIDS-defining tumors such as Kaposi sarcoma. This does not appear to be the case, however, for several noninfectious complications of AIDS, such as HIV-related lung cancer, for which studies show increased incidence in the HAART era.[4,5,9,10,12,13*,15*] This article reviews new findings regarding the occurrence of noninfectious pulmonary complications of HIV/AIDS in the HAART era, with a focus on AIDS-related lung malignancies and pulmonary hypertension. We will provide evidence-based analysis of studies published since 2003, the year of our previous review.[19]

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