Pulmonary Manifestations of

HIV/AIDS
 Diseases of the Respiratory System
• Acute bronchitis and sinusitis are prevalent during
all stages of HIV infection.
• Sinusitis presents as fever, nasal congestion, and
headache. The diagnosis is made by CT or MRI. The
maxillary sinuses are most commonly involved.
• The high incidence of sinusitis results from an
increased frequency of infection with encapsulated
organisms such as H. influenzae and Streptococcus
pneumoniae.
 Bacterial pneumonia
• Patients with HIV infection are particularly
prone to infections with encapsulated
organisms. S. pneumoniae and H. influenzae
are responsible for most cases of bacterial
pneumonia in patients with AIDS.
• Common etiological agents: S. pneumoniae
• Clinical presentation: Abrupt onset with fever,
cough, production of purulent sputum,
dyspnea, and pleuritic chest pain
• Common findings: X-ray may show pneumonic
consolidation, infiltrates, or pleural effusion;
leukocytosis; blood cultures may be positive
 Treatment
• Antibiotics: Penicillin (procaine
Pen/Crystalinne Pen), Amoxicillin
fluoroquiolone
• Supplemental Oxygen
 PCP
• The single most common cause of pneumonia
in patients with HIV infection.
• Etiologic agent: P. jiroveci is fungus
• 50% of patients experience at least one bout
of PCP during the course of their Lifetime.
• Transmitted from human to human, or from
environmental reservoirs to human.
 Clinical feature
• Mode of presentation- PCP has indolent course
characterized by weeks of vague symptoms prior to
presentation or diagnosis. Median duration of symptom
is 28 days.
• Dyspnea and fever are cardinal symptoms
• Cough with scanty sputum in > 2/3 of cases
• They may complain of a characteristic retrosternal chest
pain that is worse on inspiration
• Respiratory distress ± Cyanosis
• findings of consolidation are usually absent
• The most common finding on chest x-ray is either a normal film, if
the disease is suspected early, or a faint bilateral interstitial
infiltrate.
• leukocytosis ,elevated lactate dehydrogenase is common. Arterial
blood-gases may indicate hypoxemia with a decline in Pa O2 and an
increase in the arterial-alveolar gradient
• A definitive diagnosis of PCP requires demonstration of the
organism in samples obtained from induced sputum,
bronchoalveolar lavage, transbronchial biopsy, or open-lung biopsy.
• PCR has been used to detect specific DNA sequences for P. jiroveci
in clinical specimens where histologic examinations have failed to
make a diagnosis
• In addition to pneumonia, a number of other
clinical problems have been reported in HIV-
infected patients as a result of infection with P.
jiroveci.
• Otic involvement may be seen as a primary
infection, presenting as a polypoid mass
involving the external auditory canal.
 Treatment
• The standard treatment for PCP or disseminated
pneumocystosis is cotrimoxazole.
• Treatment should be continued for 21 days and
followed by secondary prophylaxis.
• Prophylaxis for PCP is indicated for any HIV-infected
individual who has experienced a prior bout of PCP,
any patient with a CD4+ T cell count of <200/L or a
CD4 percentage <15, any patient with unexplained
fever for >2 weeks, and any patient with a history of
oropharyngeal candidiasis.
• Primary Prophylaxis is strongly recommended
for HIV infected person with
• CD4+ count < 200/μl
• HIV associated thrush
• Unexplained fever
• Secondary prophylaxis is indicated for
patients with prior episode of PCP