Pulmonary Manifestations of HIV

Aka: Pulmonary Manifestations of HIV, HIV Related Pulmonary Complications, AIDS Associated Lung Conditions, Respiratory Illness in HIV

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II. Epidemiology

  1. HIV and Tobacco Abuse both play major roles in the increased risk of COPD and Lung Cancer in HIV patients
    1. Collini (2016) Curr Opin Infect Dis 29(1):31-8 +PMID:26555039 [PubMed]

III. Pathophysiology

  1. Chronic immune activation and systemic inflammation causes increased Prevalence of lung disease in HIV
  2. 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

IV. Causes: General lung findings in AIDS

  1. 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)
  2. 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)
  3. Parasitic
    1. Toxoplasmosis
  4. Viruses (CD4 <50)
    1. Cytomegalovirus (CMV)
    2. Herpes Simplex Virus (HSV)
  5. 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
      1. Cryptococcus
      2. Histoplasmosis
      3. Aspergillosis
      4. Candidiasis
    3. Other less common endemic fungi (consider in those living in or traveling to endemic regions)
      1. Coccidioidomycosis
      2. Blastomycosis
  6. Malignancy
    1. Kaposi's Sarcoma
    2. Non-Hodgkin's Lymphoma

V. Causes: Cavitary Lesions

  1. Tuberculosis
  2. Aspergillus
  3. Pneumocystis jiroveci Pneumonia (Pneumocystis carinii)
  4. Pneumococcus
  5. Cryptococcus neoformans
  6. Rhodococcus equi
    1. Upper lobe lung cavitary lesions with air fluid levels (distinguishes from Tuberculosis)
  7. Nocardia
  8. Gram Negative Bacilli (especially Pseudomonas)

VI. Causes: Nodular lesions

  1. Cryptococcus
  2. Histoplasmosis
  3. Tuberculosis
  4. Pneumocystis carinii
  5. Bacterial Pneumonia
  6. Malignancies
    1. Kaposi's Sarcoma
    2. Non-Hodgkin's Lymphoma

VII. Causes: Hilar Adenopathy

  1. Tuberculosis
  2. Kaposi's Sarcoma
  3. Non-Hodgkin's Lymphoma
  4. Pneumocystis carinii (Uncommon)

VIII. Causes: Pleural Effusion

  1. Tuberculosis
  2. Fungal Pneumonia
  3. Kaposi's Sarcoma
  4. Non-Hodgkin's Lymphoma

IX. Prevention

  1. Tobacco Cessation
  2. Pneumococcal Vaccine
  3. Influenza Vaccine

X. References

  1. Parker and Bond (2023) Crit Dec Emerg Med 37(10): 4-9
  2. Swadron (2019) Pulmonology 2, CCME Board Review, accessed 6/18/2019
  3. Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]
  4. Jaqua (2026) Am Fam Physician 113(1): 71-9 [PubMed]

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