PULMONARY PULMONARY COMPLICATIONS OF HIVCOMPLICATIONS OF HIV

PULMONARY COMPLICATIONS OF HIVPULMONARY COMPLICATIONS OF HIV

1.HIV AND AIDS1.HIV AND AIDS

2.HIV AND LUNG DEFENCES2.HIV AND LUNG DEFENCES

3.CASE DEFINITION OF AIDS AND CLASSIFICATION INTO 3.CASE DEFINITION OF AIDS AND CLASSIFICATION INTO CLINICAL CATEGORIESCLINICAL CATEGORIES

4.PROGRESSIVE IMMUNOSUPPRESSION4.PROGRESSIVE IMMUNOSUPPRESSION

5.CHEST RADIOGRAPH FINDINGS IN PATIENTS WITH HIV 5.CHEST RADIOGRAPH FINDINGS IN PATIENTS WITH HIV INFECTIONINFECTION

6.INFECTIOUS AND NON INFECTIOUS RESPIRATORY TRACT 6.INFECTIOUS AND NON INFECTIOUS RESPIRATORY TRACT COMPLICATIONS OF PATIENTS WITH HIV INFECTIONCOMPLICATIONS OF PATIENTS WITH HIV INFECTION

7.CLINICAL EVALUATION OF A PATIENT WITH HIV INFECTION 7.CLINICAL EVALUATION OF A PATIENT WITH HIV INFECTION AND RESPIRATORY DISEASEAND RESPIRATORY DISEASE

Human Human immunodeficiency immunodeficiency

virusvirus

Human immunodeficiency virusHuman immunodeficiency virus

Group:GroupGroup:Group VI VI ((ssRNAssRNA--RTRT))Family: Family: RRetroviridaeetroviridaeGenus:Genus:LentivirusLentivirusSpecies:HumanSpecies:Human immunodeficiencimmunodeficienc y virus 1 & 2y virus 1 & 2

HIV - 1

M (MAJOR)WORLD-WIDE

O (OUTLIER)WEST AFRICA

N (MINOR)RARE,

HIGHLY DIVERGENT

Further divided into subtypes or Further divided into subtypes or cladesclades--subtype C found in Indiasubtype C found in India

HIV AND AIDSHIV AND AIDS

AIDS AIDS –– first first recognisedrecognised in 1981in 1981–– when the U.S, C.D.C reported the when the U.S, C.D.C reported the ocurrenceocurrence of of pneumocystispneumocystis cariniicariniipneumonia in 5 previously healthypneumonia in 5 previously healthyhomosexual men.homosexual men.

AIDS & PULMONARY COMPLICATIONSAIDS & PULMONARY COMPLICATIONS-- 70% of patients with HIV have pulmonary70% of patients with HIV have pulmonarycomplications during lifecomplications during life

--additional pulmonary pathology is often an additional pulmonary pathology is often an autopsyautopsy

finding finding

The 1993 AIDS The 1993 AIDS Surveillance Case Surveillance Case

Definition of the U.S. Definition of the U.S. Centers for Disease Centers for Disease

Control and PreventionControl and Prevention

A diagnosis of AIDS is made A diagnosis of AIDS is made whenever a person is HIVwhenever a person is HIV-- positive and: positive and: he or she has a CD4+ cell count below he or she has a CD4+ cell count below 200 cells per 200 cells per microlitermicroliter OR OR his or her CD4+ cells account for fewer his or her CD4+ cells account for fewer than 14 percent of all lymphocytes OR than 14 percent of all lymphocytes OR that person has been diagnosed with one that person has been diagnosed with one or more of the AIDSor more of the AIDS--defining illnesses defining illnesses listed below. listed below.

Clinical categories of Clinical categories of HIV infectionHIV infection

Clinical categories of HIV Clinical categories of HIV infection are defined as :infection are defined as :

Category ACategory A consists of one or more of the conditions consists of one or more of the conditions listed below in an adolescent or adult (> 13 listed below in an adolescent or adult (> 13 years) with documented HIV infection. years) with documented HIV infection. Conditions listed in Categories B and C Conditions listed in Categories B and C must not have occurred.must not have occurred.Asymptomatic HIV infection Asymptomatic HIV infection Persistent generalized Persistent generalized lymphadenopathylymphadenopathyAcute (primary) HIV infection with Acute (primary) HIV infection with accompanying illness or history of acute accompanying illness or history of acute HIV infection HIV infection

Category BCategory B

consists of symptomatic conditions in HIVconsists of symptomatic conditions in HIV-- infected adolescent or adult, not included infected adolescent or adult, not included in Category C & that meet at least one of in Category C & that meet at least one of following criteria: following criteria: The conditions are attributed to HIV The conditions are attributed to HIV infection or indicate a defect in CMI.infection or indicate a defect in CMI.The conditions are considered by The conditions are considered by physicians to have a clinical course or to physicians to have a clinical course or to require management that is complicated require management that is complicated by HIV infection. by HIV infection.

Category BCategory BExamples of conditions in clinical Category B include, but are Examples of conditions in clinical Category B include, but are not limited to not limited to

Bacillary Bacillary angiomatosisangiomatosisCandidiasis, Candidiasis, oropharyngealoropharyngeal (thrush) (thrush) Candidiasis, Candidiasis, vulvovaginalvulvovaginal: persistent, frequent, or poorly : persistent, frequent, or poorly responsive to therapy responsive to therapy Cervical Cervical dysplasiadysplasia (moderate or severe)/cervical CIS (moderate or severe)/cervical CIS Constitutional Constitutional symptoms,eg.feversymptoms,eg.fever (38.5 C) or diarrhea >1mth (38.5 C) or diarrhea >1mth Hairy Hairy leukoplakialeukoplakia, oral , oral Herpes zoster Herpes zoster --at least 2 distinct episodes or >1 dermatome at least 2 distinct episodes or >1 dermatome Idiopathic thrombocytopenic Idiopathic thrombocytopenic purpurapurpuraListeriosisListeriosisPelvic inflammatory Pelvic inflammatory dsds, , espesp tubotubo--ovarian abscess ovarian abscess Peripheral neuropathyPeripheral neuropathy

Category CCategory C--includes the clinical conditions listed in includes the clinical conditions listed in the AIDS surveillance case definition.the AIDS surveillance case definition.

--For classification purposes, once a For classification purposes, once a Category C condition occurs, the person Category C condition occurs, the person will remain in Category C.will remain in Category C.

AIDS Defining AIDS Defining ConditionsConditions

AIDS Defining ConditionsAIDS Defining Conditions

Candidiasis of bronchi, trachea, or Candidiasis of bronchi, trachea, or lungs lungs Candidiasis, esophageal Candidiasis, esophageal Cervical cancer, invasive Cervical cancer, invasive CoccidioidomycosisCoccidioidomycosis, disseminated or , disseminated or extrapulmonaryextrapulmonaryCryptococcosisCryptococcosis, , extrapulmonaryextrapulmonaryCryptosporidiosis, chronic intestinal Cryptosporidiosis, chronic intestinal (>1 month's duration(>1 month's duration) )

AIDS Defining ConditionsAIDS Defining Conditions contdcontd

CMV disease (other than liver, spleen, or CMV disease (other than liver, spleen, or nodes) nodes) CMV retinitis (with loss of vision)CMV retinitis (with loss of vision)Encephalopathy, HIVEncephalopathy, HIV--related related Herpes simplex: chronic Herpes simplex: chronic ulcer(sulcer(s) (>1 ) (>1 month's duration); or bronchitis, month's duration); or bronchitis, pneumonitispneumonitis, or , or esophagitisesophagitisHistoplasmosisHistoplasmosis, disseminated or , disseminated or extrapulmonaryextrapulmonaryIsosporiasisIsosporiasis chronic intestinal (>1 month'schronic intestinal (>1 month's

AIDS Defining ConditionsAIDS Defining Conditions-- contdcontd

Kaposi's sarcoma Kaposi's sarcoma Lymphoma, Lymphoma, Burkitt'sBurkitt's (or equivalent term) (or equivalent term) Lymphoma, Lymphoma, immunoblasticimmunoblastic (or equivalent (or equivalent term) term) Lymphoma, primary, of brain Lymphoma, primary, of brain MAIC or M. MAIC or M. kansasiikansasii, disseminated or , disseminated or extrapulmonaryextrapulmonaryM. tuberculosis, any site (pulmonary or M. tuberculosis, any site (pulmonary or extrapulmonaryextrapulmonary) Mycobacterium, other ) Mycobacterium, other species or unidentified species, species or unidentified species, disseminated or disseminated or extrapulmonaryextrapulmonary

AIDS Defining ConditionsAIDS Defining Conditions-- contdcontd

PneumocystisPneumocystis cariniicarinii pneumonia pneumonia Pneumonia, recurrent Pneumonia, recurrent Progressive Progressive multifocalmultifocal leukoencephalopathyleukoencephalopathySalmonella septicemia, recurrent Salmonella septicemia, recurrent Toxoplasmosis of brain Toxoplasmosis of brain Wasting syndrome due to HIV Wasting syndrome due to HIV

Additional Illnesses That Are Additional Illnesses That Are AIDSAIDS--Defining in Children, But Defining in Children, But

Not AdultsNot Adults

Multiple, recurrent bacterial infections Multiple, recurrent bacterial infections

Lymphoid interstitial pneumonia/ Lymphoid interstitial pneumonia/ pulmonary lymphoid hyperplasia pulmonary lymphoid hyperplasia

1993 Revised 1993 Revised Classification System Classification System for HIV Infection and for HIV Infection and

AIDSAIDS

1993 Revised Classification System for HIV Infection and Expande1993 Revised Classification System for HIV Infection and Expanded d AIDS Surveillance Case Definition for Adolescents and AdultsAIDS Surveillance Case Definition for Adolescents and Adults

CD4+ T cellsCD4+ T cells Clinical CategoriesClinical Categories

(A) Symptomatic, (A) Symptomatic, Acute (Primary) Acute (Primary) HIV or PGL*HIV or PGL*

(B) CD4+ T cells (B) CD4+ T cells Symptomatic, Not Symptomatic, Not (A) or (C) (A) or (C) ConditionsConditions

(C) AIDS(C) AIDS-- Indicator Indicator ConditionsConditions

(1) >500/mL(1) >500/mL A1A1 B1B1 C1C1

(2) 200(2) 200--499/mL499/mL A2A2 B2B2 C2C2

(3) <200/mL(3) <200/mL AIDSAIDS--Indicator TIndicator T-- cell countcell count

>A3>A3 B3B3 C3C3

PGLPGL--persistent generalized persistent generalized lymphadenopathylymphadenopathy. Clinical Category A includes acute (primary) HIV infection.. Clinical Category A includes acute (primary) HIV infection.

The three CD4+ TThe three CD4+ T--lymphocyte lymphocyte categories are defined as follows:categories are defined as follows:Category 1Category 1: >500/mL : >500/mL Category 2Category 2: 200: 200--499/mL 499/mL Category 3Category 3: <200/mL : <200/mL

These correspond to CD4+ TThese correspond to CD4+ T--lymphocyte counts lymphocyte counts per per mLmL of blood & guide clinical & therapeutic of blood & guide clinical & therapeutic actions in mgt of HIVactions in mgt of HIV--infected adolescents and infected adolescents and adults. The revised HIV classification system adults. The revised HIV classification system also allows for the use of the percentage of also allows for the use of the percentage of CD4+ T cells. CD4+ T cells.

Revised WHO Clinical Revised WHO Clinical Staging of HIV/AIDS For Staging of HIV/AIDS For Adults and Adolescents Adults and Adolescents

(2005)(2005)

Primary HIV infectionPrimary HIV infectionAsymptomatic Asymptomatic Acute retroviral syndrome Acute retroviral syndrome

Clinical stage 1Clinical stage 1Asymptomatic Asymptomatic Persistent generalized Persistent generalized lymphadenopathylymphadenopathy

Clinical stage 2Clinical stage 2Moderate and unexplained weight loss (<10% of Moderate and unexplained weight loss (<10% of presumed or measured body weight) presumed or measured body weight) Recurrent respiratory tract infections (Recurrent respiratory tract infections (sinusitissinusitis, , bronchitisbronchitis, , otitisotitis media, media, pharyngitispharyngitis) ) Herpes zosterHerpes zosterRecurrent oral ulcerations Recurrent oral ulcerations PapularPapular pruriticpruritic eruptions eruptions Angular Angular cheilitischeilitisSeborrhoeicSeborrhoeic dermatitis dermatitis Fungal finger nail infections Fungal finger nail infections

Clinical stage 3Clinical stage 3Conditions where a presumptive diagnosis can be Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple made on the basis of clinical signs or simple investigationsinvestigationsUnexplained chronic Unexplained chronic diarrhoeadiarrhoea >1mth>1mthUnexplained persistent fever (intermittent or constant >1 Unexplained persistent fever (intermittent or constant >1 mthmth))Severe weight loss (>10% of presumed or measured Severe weight loss (>10% of presumed or measured body wt) w body wt) w Oral Oral candidiasiscandidiasisOral hairy Oral hairy leukoplakialeukoplakiaPulmonary TB diagnosed in last two years Pulmonary TB diagnosed in last two years Severe presumed bacterial infections (e.g. pneumonia, Severe presumed bacterial infections (e.g. pneumonia, empyema, meningitis, empyema, meningitis, bacteraemiabacteraemia, , pyomyositispyomyositis, bone or , bone or joint infection) joint infection) Acute necrotizing ulcerative Acute necrotizing ulcerative stomatitisstomatitis, gingivitis or , gingivitis or periodontitisperiodontitisConditions where confirmatory diagnostic testing isConditions where confirmatory diagnostic testing is

Clinical stage 4Clinical stage 4Conditions where a presumptive diagnosis Conditions where a presumptive diagnosis can be made on the basis of clinical signs can be made on the basis of clinical signs or simple investigationsor simple investigationsHIV wasting syndrome HIV wasting syndrome PneumocystisPneumocystis pneumonia pneumonia Recurrent severe or radiological bacterial Recurrent severe or radiological bacterial pneumonia pneumonia Chronic herpes simplex Chronic herpes simplex infninfn >1mth (>1mth (orolabialorolabial, , genital or genital or anorectalanorectal) ) OesophagealOesophageal candidiasis candidiasis ExtrapulmonaryExtrapulmonary Tuberculosis Tuberculosis KaposiKaposi’’s sarcoma s sarcoma CNS toxoplasmosis CNS toxoplasmosis HIV encephalopathy HIV encephalopathy

Clinical stage 4Clinical stage 4Conditions where confirmatory diagnostic testing is Conditions where confirmatory diagnostic testing is necessarynecessaryExtrapulmonaryExtrapulmonary cryptococcosiscryptococcosis including meningitis including meningitis Disseminated nonDisseminated non--tuberculoustuberculous mycobacteriamycobacteria infection infection Progressive Progressive multifocalmultifocal leukoencephalopathyleukoencephalopathyCandida of trachea, bronchi or lungs Candida of trachea, bronchi or lungs Cryptosporidiosis Cryptosporidiosis IsosporiasisIsosporiasisVisceral herpes simplex infection Visceral herpes simplex infection CMVCMV infection (retinitis or of organ other than liver, spleen or infection (retinitis or of organ other than liver, spleen or lymph nodes) lymph nodes) Disseminated mycosis (Disseminated mycosis (histoplasmosishistoplasmosis, , coccidiomycosiscoccidiomycosis, , penicilliosispenicilliosis) ) Recurrent nonRecurrent non--typhoidaltyphoidal salmonella salmonella septicaemiasepticaemiaLymphoma (cerebral or B cell NHL) Lymphoma (cerebral or B cell NHL) Invasive cervical carcinoma Invasive cervical carcinoma Visceral Visceral leishmaniasisleishmaniasis

Pulmonary Pulmonary complications in complications in

patients with HIV patients with HIV infectioninfection

--infectiousinfectious --non infectiousnon infectious

Table 1: Pulmonary complications in patients with HIV infectionTable 1: Pulmonary complications in patients with HIV infection

InfectionsInfections NeoplasiaNeoplasia OtherOther

PneumocystisPneumocystis jirovecijiroveci

Kaposi's sarcomaKaposi's sarcoma

NonNon--Hodgkin's lymphomaHodgkin's lymphoma

Hodgkin's lymphomaHodgkin's lymphoma

Bronchial carcinomaBronchial carcinoma

--LIP,LIP,--NSIP,NSIP,--BOOP,BOOP,--Pulmonary Pulmonary Hypertension,Hypertension,--COPD,COPD,--Bronchial Bronchial hyperreactivityhyperreactivity

ProtozoalProtozoal infectionsinfectionsStrogyloidesStrogyloides stercoralisstercoralis,,ToxoplasmaToxoplasma gondiigondii,,Cryptosporidium Cryptosporidium parvumparvum

Bacterial pneumoniaBacterial pneumoniaS. S. pneumoniaepneumoniaeS. S. aureusaureusH. H. influenzaeinfluenzaeB. B. catarrhaliscatarrhalisP.aeruginosaP.aeruginosaRhodococcusRhodococcus equiequiNocardiaNocardia asteroidesasteroidesMycobacteriaMycobacteriaM. tuberculosisM. tuberculosisAtypical Atypical mycobacteriamycobacteriaFungal pneumoniaFungal pneumoniaAspergillusAspergillus sppspp..Cryptococcus Cryptococcus neoformansneoformansHistoplasmaHistoplasma capsulatumcapsulatumCoccidioidesCoccidioides immitisimmitisViral Viral pneumonitispneumonitisCMV, Herpes CMV, Herpes simplex,Varicellasimplex,Varicella zoster ,zoster ,

INFECTIOUS INFECTIOUS PULMONARY PULMONARY

COMPLICATIONS COMPLICATIONS IN HIVIN HIV

••InfectiousInfectious--•• Upper respiratory infectionsUpper respiratory infections•• Acute bronchitisAcute bronchitis•• Acute sinusitis (viral, bacterial, fungal)Acute sinusitis (viral, bacterial, fungal)

••Bacterial pneumoniaBacterial pneumonia--•• S. S. pneumoniaepneumoniae•• S. S. aureusaureus•• H. H. influenzaeinfluenzae•• B. B. catarrhaliscatarrhalis•• P.aeruginosaP.aeruginosa•• RhodococcusRhodococcus equiequi•• NocardiaNocardia asteroidesasteroides

MycobacteriaMycobacteriaM. tuberculosisM. tuberculosisAtypical Atypical mycobacteriamycobacteria

Fungal pneumoniaFungal pneumoniaPneumocystisPneumocystis jirovecijiroveciAspergillusAspergillus sppspp..Cryptococcus Cryptococcus neoformansneoformansHistoplasmaHistoplasma capsulatumcapsulatumCoccidioidesCoccidioides immitisimmitis

ProtozoalProtozoal infectionsinfectionsStrongyloidesStrongyloides stercoralisstercoralis,,ToxoplasmaToxoplasma gondiigondii,,Cryptosporidium Cryptosporidium parvumparvum

Viral Viral pneumonitispneumonitisCMV,CMV,Herpes simplex,Herpes simplex,VaricellaVaricella zosterzoster

NONNON--INFECTIOUS INFECTIOUS PULMONARY PULMONARY

COMPLICATIONS IN COMPLICATIONS IN HIVHIV

MALIGNANCIESMALIGNANCIESKaposiKaposi’’s sarcomas sarcomaNon Non hodgkinhodgkin’’ss lymphomalymphomaHodgkinHodgkin’’s lymphomas lymphomaAdenocarcinomaAdenocarcinoma lunglung

OthersOthersLymphocyticLymphocytic interstitial interstitial pneumonitispneumonitisNonNon--specific interstitial specific interstitial pneumonitispneumonitisBronchiolitisBronchiolitis obliteransobliterans organizing organizing pneumoniapneumoniaPrimary pulmonary hypertensionPrimary pulmonary hypertensionPulmonary embolismPulmonary embolism

CHEST RADIOGRAPH CHEST RADIOGRAPH FINDINGS IN FINDINGS IN

PATIENTS WITH HIV PATIENTS WITH HIV INFECTIONINFECTION

Without pathological findingsWithout pathological findings

PneumocystisPneumocystis CariniiCarinii Pneumonia,Pneumonia,Asthma, Asthma, Kaposi Kaposi Sarcoma of the Sarcoma of the tracheatrachea

Pleural effusionPleural effusion

Bacterial Bacterial pneumonia, pneumonia, mycobacteriosismycobacteriosis, , Kaposi Sarcoma, Kaposi Sarcoma, lymphoma, lymphoma, cardiac cardiac insufficiencyinsufficiency

PneumothoraxPneumothorax

PneumocystiPneumocysti ss CariniiCarinii PneumoniaPneumonia

MiliaryMiliary imageimageMycobacterioMycobacterio sissisfungifungi

Bilateral Bilateral hilarhilar lymphadenopathylymphadenopathy

MycobacteriosiMycobacteriosi ss, , KS, KS, sarcoidosissarcoidosis

Diffuse infiltratesDiffuse infiltratesPCP (centrally PCP (centrally pronounced),pronounced),CMV, CMV, KS,KS,LIP, LIP, cardiac cardiac insufficiency,insufficiency,fungifungi

Focal infiltratesFocal infiltratesBacterial Bacterial pneumonia,pneumonia,mycobacteriosismycobacteriosis,,lymphoma,lymphoma,fungifungi

Cystic lesionsCystic lesionsPCP, PCP, fungifungi

Chest xChest x--rayray

MultifocalMultifocal infiltratesinfiltrates --Bacterial Bacterial pneumonia, pneumonia, mycobacteriosismycobacteriosis, PCP,, PCP, KSKS

Cavernous lesionsCavernous lesions -- MycobacteriosisMycobacteriosis (CD4 > 200), (CD4 > 200), bacterial abscess (bacterial abscess (StaphStaph.,

Cigarette Smoking in Cigarette Smoking in HIV InfectionHIV Infection

Cigarette Smoking in HIV Infection Cigarette Smoking in HIV Infection

cigarette smokingcigarette smokinginduces a compartmentalized, suppressive lung inflammatory induces a compartmentalized, suppressive lung inflammatory environment in HIVenvironment in HIV--positive individuals. positive individuals.

associated with a marked depression in both the percentage and associated with a marked depression in both the percentage and absolute numbers of lung lymphocytes. Lung CD4+ and lung CD8+ ceabsolute numbers of lung lymphocytes. Lung CD4+ and lung CD8+ cell ll numbers were suppressed by smoking, and lung CD4+/CD8+ cell ratinumbers were suppressed by smoking, and lung CD4+/CD8+ cell ratios os trended toward lower values in smokers.trended toward lower values in smokers.

HIVHIV--infected smokers had increased numbers of AM recovered by BAL infected smokers had increased numbers of AM recovered by BAL and showed suppressed spontaneous production of the and showed suppressed spontaneous production of the proinflammatoryproinflammatory cytokines ILcytokines IL--1 and TNF. These compartmentalized 1 and TNF. These compartmentalized changes in the lung contrast with the lack of a defect in periphchanges in the lung contrast with the lack of a defect in peripheral eral blood CD4+ cells in cigarette smokers. blood CD4+ cells in cigarette smokers.

Cigarette Smoking in HIV Infection Induces a Suppressive InflammCigarette Smoking in HIV Infection Induces a Suppressive Inflammatory Environment in the Lung atory Environment in the Lung MARKMARK D. WEWERS, PHILIPD. WEWERS, PHILIP T. DIAZ, MARYT. DIAZ, MARY ELLEN WEWERS, MELISSAELLEN WEWERS, MELISSA P. LOWE, HAIKADYP. LOWE, HAIKADY N. NAGARAJA, and THOMASN. NAGARAJA, and THOMAS L. CLANTONL. CLANTONAm. J. Am. J. RespirRespir. . CritCrit. Care Med., Volume 158, Number 5, November 1998, 1543. Care Med., Volume 158, Number 5, November 1998, 1543--15491549

EFFECTS OF HIV IN EFFECTS OF HIV IN THE LUNGTHE LUNG

--HIV infection of lung cellsHIV infection of lung cells

--HIV and lung host defensesHIV and lung host defenses

HIV infection of lung HIV infection of lung cellscells

HIV infection of lung cellsHIV infection of lung cells

HIV entry into lung cells is mediated by the HIV entry into lung cells is mediated by the CD4+ molecule on the cell surface.CD4+ molecule on the cell surface.

HIV infection of human alveolar HIV infection of human alveolar macrophages is preferentially mediated by macrophages is preferentially mediated by the CCR5 receptor.the CCR5 receptor.

HIV AND LUNG HIV AND LUNG DEFENCESDEFENCES

HIV and lung host defensesHIV and lung host defenses

Progressive HIV infection decreases Progressive HIV infection decreases numbers of lung CD4+ T cellsnumbers of lung CD4+ T cellsCauses intense infiltration of CD8+ T cells Causes intense infiltration of CD8+ T cells in the in the interstitiuminterstitium and alveolar spaces.and alveolar spaces.Called as LYMPHOCYTIC ALVEOLITISCalled as LYMPHOCYTIC ALVEOLITISPronounced in patients with early to Pronounced in patients with early to middle stage diseasemiddle stage diseaseCaused by Caused by compartmentalisationcompartmentalisation of HIV of HIV specific specific cytotoxiccytotoxic T cellsT cells

PROGRESSIVE PROGRESSIVE IMMUNOSUPPRESSIONIMMUNOSUPPRESSION

PROGRESSIVE PROGRESSIVE IMMUNOSUPPRESSIONIMMUNOSUPPRESSION

Spectrum of respiratory diseases changes Spectrum of respiratory diseases changes as immunodeficiency developsas immunodeficiency develops

In case of normal CD4+ count and In case of normal CD4+ count and undetectable or low HIVundetectable or low HIV--RNA in blood RNA in blood –– risk of opportunistic infection is lowrisk of opportunistic infection is low

More virulent organisms cause problems More virulent organisms cause problems earlier in the natural history of HIV earlier in the natural history of HIV infectioninfection

3 by 5 3 by 5 initiativeinitiative --WHOWHOOn 22 September 2003, the leaders On 22 September 2003, the leaders of UNAIDS, WHO, and the Global of UNAIDS, WHO, and the Global Fund to Fight AIDS, Tuberculosis and Fund to Fight AIDS, Tuberculosis and Malaria joined together to declare Malaria joined together to declare the lack of access to antiretroviral the lack of access to antiretroviral drugs to be a global health drugs to be a global health emergency. In response, the "Treat emergency. In response, the "Treat 3 Million by 2005" (3 by 5) Initiative 3 Million by 2005" (3 by 5) Initiative was launched. was launched.

TO CONCLUDETO CONCLUDE....

Although, most of the Although, most of the pulmonary complications of HIV pulmonary complications of HIV infection are not unique to the infection are not unique to the disease, the variability and nondisease, the variability and non-- specificity of clinical and radiological specificity of clinical and radiological findings in these patients frequently findings in these patients frequently complicate their diagnosis.complicate their diagnosis.