The Changing Spectrum of Pulmonary Disease in Patients with HIV Infection on Antiretroviral Therapy

Jessica R Grubb; Anne C Moorman; Rose K Baker; Henry Masur; the HOPS investigators


AIDS. 2006;20(8):1095-1107. 

In This Article


The pulmonary manifestations of HIV disease in 2005 can be divided into two sets of presentations. For patients who do not have access to care, and who are not taking antiretroviral or chemoprophylactic drugs, opportunistic infections and neoplasms continue to occur. Pulmonary disease caused by Streptococcus pneumoniae, Pneumocystis carinii (now known as Pneumocystis jiroveci pneumonia; PCP), Mycobacterium tuberculosis, lymphoma, and Kaposi's sarcoma present much as they did in the 1980s. Management has improved in terms of new diagnostic, therapeutic, and preventive strategies, as reviewed in guidelines issued jointly by the National Institutes of Health, Centers for Disease Control and Prevention, and Infectious Disease Society of America (available online at

Patients in the United States who are taking combination antiretroviral therapy (ART) and specific chemoprophylaxis demonstrate very different manifestations compared with patients in the 1980s who were receiving no ART or chemoprophylaxis. Some of these new manifestations are caused by the augmented immune response that occurs soon after ART is instituted, i.e. immune reconstitution syndromes. Other new manifestations are facilitated by prolonged patient survival at both high and low CD4 T-lymphocyte counts that result from ART. This prolonged survival has allowed other processes to occur after long periods of immunosuppression, e.g. neoplastic processes such as lymphoma and perhaps various solid tumors, and other entities such as pulmonary hypertension. This review will focus primarily on changing pulmonary manifestations in the populations in the United States and western Europe that have access to ART.


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