HIV - Respiratory Manifestations

2/22/2005

Question:  What are the common respiratory manifestations of HIV disease?

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15765925[PMID] OR 12226027[PMID] OR 11987767[PMID] OR 11928165[PMID] OR 11742918[PMID] OR 11739145[PMID] OR 9001292[PMID] OR 9016368[PMID] OR 8676614[PMID] OR 8709692[PMID] OR 8712766[PMID] OR 16044571[PMID] OR 15728594[PMID] OR 12226010[PMID] OR 11266236[PMID] OR 10812650[PMID] OR 10638511[PMID] OR 9799133[PMID] OR 9567321[PMID] OR 9567320[PMID] OR 9298088[PMID] OR 8976923[PMID] OR 8953614[PMID] OR 8571866[PMID] OR 9363057[PMID] OR 7574440[PMID] OR 7660346[PMID] OR 10144743[PMID] OR 7774325[PMID] OR 7939794[PMID] OR 8059005[PMID] OR 8058993[PMID] OR 8306736[PMID] OR 8256894[PMID] OR 8369787[PMID] OR 8102043[PMID] OR 8419749[PMID] OR 1417282[PMID] OR 1571469[PMID] OR 1889255[PMID] OR 1871267[PMID] OR 1871266[PMID] OR 1859769[PMID] OR 2026243[PMID] OR 2240021[PMID] OR 2198162[PMID] OR 2187388[PMID] OR 2181720[PMID] OR 2181719[PMID] OR 2562248[PMID] OR 2701508[PMID] OR 2690709[PMID] OR 2689064[PMID] OR 2685952[PMID] OR 2655853[PMID] OR 3044685[PMID] OR 3282587[PMID]

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<1>

Unique Identifier [PMID]: 15765925

Authors: Dufour V. Cadranel J. Wislez M. Lavole A. Bergot E. Parrot A. Rufat P. Mayaud C.

Institution: Service de Pneumologie et de Reanimation Respiratoire, AP-HP Hopital Tenon, Paris, France.

Title: Changes in the pattern of respiratory diseases necessitating hospitalization of HIV-infected patients since the advent of highly active antiretroviral therapy.

Source: Lung. 182(6):331-41, 2004.

Abstract: The incidence rates of opportunistic diseases, hospital admission and death have fallen markedly since the advent of highly active antiretroviral therapy (HAART). We examined the impact of HAART on the pattern of HIV-related respiratory diseases necessitating hospitalization. We retrospectively compared the numbers and etiologies of respiratory diseases diagnosed in HIV-infected patients hospitalized in the chest department of a Paris university hospital during the three years preceding widespread prescription of HAART in France (era 1, starting in July 1993) and the first three years of widespread HAART prescription (era 2, starting in July 1996). Respectively, 207 and 119 HIV-infected patients were admitted for respiratory disease in era 1 and era 2. Only 31.1% of patients admitted during era 2 were receiving HAART. Pulmonary opportunistic infections other than Pneumocystis carinii pneumonia (PCP) (p = 0.0008) and exacerbations of chronic bronchial disease due to gram-negative bacilli (p = 0.04) virtually disappeared in era 2. In contrast, PCP, bacterial pneumonia, tuberculosis, pulmonary Kaposi's sarcoma and pulmonary non-Hodgkin lymphoma showed only a twofold decrease in era 2, while lung cancer was more frequent (p = 0.004). The frequency of severe respiratory diseases necessitating hospitalization of HIV-infected patients has fallen since the advent of HAART, and their etiologic distribution has changed.

Publication Type: Journal Article.

<2>

Unique Identifier [PMID]: 12226027

Authors: Taggart S. Breen R. Goldsack N. Sabin C. Johnson M. Lipman M.

Institution: Royal Free Hospital HIV Centre, Hampstead, London, UK. scotaggart@hotmail.com

Title: The changing pattern of bronchoscopy in an HIV-infected population.[see comment].

Comments Comment in: Chest. 2002 Sep;122(3):768-71; PMID: 12226010

Source: Chest. 122(3):878-85, 2002 Sep.

Abstract: STUDY OBJECTIVE:s: Little information exists on the impact of antiretroviral therapies (ARTs) on HIV-related bronchoscopic activity. This study was performed to identify any changes to our pattern of use of bronchoscopy over the last decade, and how this might relate to the introduction of more effective ARTs to our center in 1996. DESIGN: Retrospective data analysis. SETTING: Academic medical center. PATIENTS: HIV-positive patients attending the clinic. METHODS: Basic demographic details and bronchoscopy status were collected and compared for all patients with HIV attending our center between 1989 and 1998. Poisson regression analysis was performed to more formally identify the risk factors for bronchoscopy. Individual case notes and bronchoscopic findings were also examined for all patients undergoing bronchoscopy in 1990, 1995, and 1998. RESULTS: From 1996 to 1998, bronchoscopic rates fell dramatically by 60% (p < 0.0001) despite a linear increase in patients receiving follow-up. Prior use of protease inhibitor (PI)/nonnucleoside reverse transcriptase inhibitor (NNRTI) combinations was significantly associated with a decreased risk of bronchoscopy even after adjusting for CD4 counts. Indications for bronchoscopy and diagnostic yield remained relatively stable in 1990, 1995, and 1998, although rates of pulmonary infection (Pneumocystis carinii pneumonia, bacteria, and virus) requiring bronchoscopy among our HIV population fell significantly from 1990 to 1998. CONCLUSION: Improvements in HIV health care are having a dramatic impact on the rates of certain pulmonary infections requiring bronchoscopy. Of these, the introduction of more effective ARTs to our service in 1996 seems most closely related to the temporal decline in bronchoscopy. PI/NNRTI combinations may have additional protective effects to their recognized action on CD4 counts.

Publication Type: Journal Article.

<3>

Unique Identifier [PMID]: 11987767

Authors: Boiselle PM. Aviram G. Fishman JE.

Institution: Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA.

Title: Update on lung disease in AIDS. [Review] [130 refs]

Source: Seminars in Roentgenology. 37(1):54-71, 2002 Jan.

Abstract: Pulmonary disorders remain an important complication of HIV infection, even in the current era of potent antiretroviral therapy. Using an integrated approach that combines radiographic pattern recognition with knowledge of a patient's clinical symptoms, laboratory data, immune status level, demographic information, and drug therapy can enhance the interpretation of imaging studies in HIV-infected patients. Although chest radiography remains the mainstay of imaging the HIV-positive patient with respiratory symptoms, CT plays an increasingly important secondary role in selected cases. [References: 130]

Publication Type: Journal Article. Review.

<4>

Unique Identifier [PMID]: 11928165

Authors: Norris TG.

Title: HIV update. [Review] [73 refs]

Source: Radiologic Technology. 73(4):339-63; quiz 367-71, 2002 Mar-Apr.

Abstract: Few diseases have spread so rapidly around the world or caused such severe morbidity and mortality as HIV/AIDS. After reading this review and update on the pandemic, readers will: Know the current status of HIV/AIDS in the United States and worldwide. Understand basic concepts of epidemiology and infectious disease and how these areas of study relate to HIV. Know basic concepts of immunology and the human immune system. Recognize major clinical manifestations of HIV/AIDS and their radiographic features. Understand the importance of universal precautions in protecting health care workers from blood-borne pathogens such as HIV. Understand the legal and psychosocial issues that affect people who have AIDS. [References: 73]

Publication Type: Journal Article. Review.

<5>

Unique Identifier [PMID]: 11742918

Authors: Wolff AJ. O'Donnell AE.

Institution: Division of Pulmonary and Critical Care Medicine, Georgetown University Medical Center, Washington, DC 20007-2197, USA.

Title: Pulmonary manifestations of HIV infection in the era of highly active antiretroviral therapy.

Source: Chest. 120(6):1888-93, 2001 Dec.

Abstract: STUDY OBJECTIVES: To determine whether the spectrum of HIV-related pulmonary disease seen by a university medical center Pulmonary and Critical Care Medicine Service has changed since the introduction of highly active antiretroviral therapy (HAART). DESIGN: Retrospective chart review. SETTING: A tertiary care university hospital. PATIENTS: All HIV-infected patients referred to the Pulmonary and Critical Care Medicine Service from January 1, 1993, through December 31, 1995 (era 1) and from July 1, 1997, through June 30, 2000 (era 2). INTERVENTIONS: Inpatient and outpatient charts were reviewed for data regarding patient demographics, CD4 cell counts, viral load levels, duration of HIV seropositivity, history of opportunistic infections, and final diagnosis. RESULTS: Pneumocystis carinii pneumonia (PCP) was less common in the HAART era than in the pre-HAART era, whereas bacterial pneumonia and non-Hodgkin's lymphoma (NHL) were more common in the HAART era than in the pre-HAART era. HAART was protective against PCP (odds ratio [OR], 0.37; confidence interval [CI], 0.16 to 0.89) in a manner dependent on the CD4 cell count. Patients receiving HAART were at increased risk for the development of bacterial pneumonia (OR, 2.41; CI, 1.12 to 5.17) and NHL (OR, 15.11; CI, 3.14 to 28.32). A history of PCP indicated a risk factor for bacterial pneumonia (OR, 2.14; CI, 1.13 to 4.04). A history of cytomegalovirus infection indicated a risk factor for NHL (OR, 6.0; CI, 1.27 to 28.32). CONCLUSIONS: There have been significant changes in the spectrum of HIV-related pulmonary complications seen by our Pulmonary and Critical Care Medicine Service in the HAART era.

Publication Type: Journal Article.

<6>

Unique Identifier [PMID]: 11739145

Authors: Beck JM. Rosen MJ. Peavy HH.

Institution: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, and Veterans Affairs Medical Center, Ann Arbor, Michigan 48105-2300, USA. jamebeck@umich

Title: Pulmonary complications of HIV infection. Report of the Fourth NHLBI Workshop.

Source: American Journal of Respiratory & Critical Care Medicine. 164(11):2120-6, 2001 Dec 1.

Publication Type: Congresses.

<7>

Unique Identifier [PMID]: 9001292

Authors: Wallace JM. Hansen NI. Lavange L. Glassroth J. Browdy BL. Rosen MJ. Kvale PA. Mangura BT. Reichman LB. Hopewell PC.

Institution: Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California 91342, USA.

Title: Respiratory disease trends in the Pulmonary Complications of HIV Infection Study cohort. Pulmonary Complications of HIV Infection Study Group.

Source: American Journal of Respiratory & Critical Care Medicine. 155(1):72-80, 1997 Jan.

Abstract: We examined trends in the incidence of specific respiratory disorders in a multicenter cohort with progressive human immunodeficiency virus (HIV) disease during a 5-yr period. Individuals with a wide range of HIV disease severity belonging to three transmission categories were evaluated at regular intervals and for episodic respiratory symptoms using standard diagnostic algorithms. Yearly incidence rates of respiratory diagnoses were assessed in the cohort as a whole and according to CD4 count or HIV transmission category. The most frequent respiratory disorders were upper respiratory tract infections, but the incidence of lower respiratory tract infections increased as CD4 counts declined. Specific lower respiratory infections followed distinctive patterns according to study-entry CD4 count and transmission category. Acute bronchitis was the predominant lower respiratory infection of cohort members with entry CD4 counts > or = 200 cells/mm3. In cohort members with entry CD4 counts of 200 to 499 cells/mm3, the incidence of bacterial and Pneumocystis carinii pneumonia each increased an average of 40% per year. In members with entry CD4 counts < 200 cells/mm3, acute bronchitis, bacterial pneumonia, and P. carinii pneumonia occurred at high rates without discernible time trends, despite chemoprophylaxis in more than 80% after Year 1, and the rate of other pulmonary opportunistic infections increased over time. Each year, injecting drug users had a higher incidence of bacterial pneumonia than did homosexual men. The yearly rate of tuberculosis was < 3 episodes/100 person-yr in each entry CD4 and HIV-transmission group. We conclude that the time trends of HIV-associated respiratory disorders are determined by HIV disease stage and influenced by transmission category. Whereas acute bronchitis is prevalent during all stages of HIV infection, incidence rates of bacterial pneumonia and P. carinii pneumonia rise continuously during progression to advanced disease. In advanced disease, the incidence of acute bronchitis, bacterial pneumonia and P. carinii pneumonia is high despite widespread chemoprophylaxis.

Publication Type: Journal Article. Multicenter Study.

<8>

Unique Identifier [PMID]: 9016368

Authors: Rosen MJ.

Institution: Division of Pulmonary and Critical Care Medicine, Beth Israel Medical Center, New York, New York, USA.

Title: Overview of pulmonary complications. [Review] [79 refs]

Source: Clinics in Chest Medicine. 17(4):621-31, 1996 Dec.

Abstract: Pulmonary diseases continue to be important causes of illness and death in patients with HIV infection, but changes in therapy and demographics of HIV-infected populations are changing their manifestations. The risk of developing specific disorders is related to the area of residence, degree of immunosuppressions, HIV risk group, and use of prophylactic therapies. Bronchitis and sinusitis occur commonly in the general population but more frequently in HIV-infected persons. The increasing population of HIV-infected drug users is reflected in the increasing incidence of bacterial pneumonia and tuberculosis. Antipneumocystis prophylaxis has reduced the incidence of and mortality rate from this infection, and adjunctive corticosteriod therapy has improved the outlook for respiratory failure. Increased longevity, however, carries the risk of developing other opportunistic infections and neoplasms, some previously rare in AIDS. [References: 79]

Publication Type: Journal Article. Review.

<9>

Unique Identifier [PMID]: 8676614

Authors: Huang L. Stansell JD.

Institution: Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, CA 94110, USA.

Title: AIDS and the lung. [Review] [114 refs]

Source: Medical Clinics of North America. 80(4):775-801, 1996 Jul.

Abstract: Respiratory symptoms are common in HIV-infected persons. The challenge facing clinicians is to determine whether these respiratory symptoms are due to an opportunistic infection or to a chronic process, such as asthma, chronic bronchitis, bronchiectasis, or emphysema. This article reviewed the clinical presentation, diagnosis, and treatment of two important opportunistic infections, PCP and bacterial pneumonia. It also reviewed the current data on obstructive lung diseases as they relate to HIV. [References: 114]

Publication Type: Journal Article. Review.

<10>

Unique Identifier [PMID]: 8709692

Authors: Miller R.

Institution: Department of Sexually Transmitted Diseases, University College London Medical School, UK.

Title: HIV-associated respiratory diseases.[see comment]. [Review] [50 refs]

Comments Comment in: Lancet. 1996 Sep 28;348(9031):892; PMID: 8826827, Comment in: Lancet. 1996 Sep 28;348(9031):892-3; PMID: 8826828, Comment in: Lancet. 1996 Sep 28;348(9031):893; PMID: 8826829

Source: Lancet. 348(9023):307-12, 1996 Aug 3.

Abstract: The lungs of individuals infected with HIV are often affected by opportunistic infections and tumours; over two-thirds of patients have at least one respiratory episode during the course of their disease. Despite the availability of effective prophylaxis, infection with the fungus Pneumocystis carinii remains a common cause of respiratory disease. Bacterial infections, which occur more frequently in HIV-infected persons than in the general population, and tuberculosis are increasing causes of morbidity and mortality. Kaposi's sarcoma, the commonest HIV-associated malignancy, may affect the lungs in addition to the skin. Pulmonary involvement by non-Hodgkin lymphoma is common in those with disseminated disease. [References: 50]

Publication Type: Journal Article. Review.

<11>

Unique Identifier [PMID]: 8712766

Authors: Murray JF.

Institution: Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital Medical Center, University of California 94143, USA.

Title: Pulmonary complications of HIV infection. [Review] [30 refs]

Source: Annual Review of Medicine. 47:117-26, 1996.

Abstract: Pulmonary disease is a major source of morbidity and mortality in HIV-infected persons. Pneumocystis carinii pneumonia has decreased substantially during the last eight years, but in the United States it remains the most common disorder that announces the onset of AIDS. In contrast, tuberculosis is by far the most important AIDS-associated indicator disease in developing countries. Community-acquired acute bacterial pneumonia is a common HIV-linked complication throughout the world; pneumonia occurs at all levels of immune suppression but increases in frequency as CD4 counts decrease. Fungal infections mainly afflict persons who live or have lived in the various endemic areas. AIDS-related Kaposi's sarcoma and lymphoma generally do not involve the lungs until the malignancies are advanced. The increasing use of successful chemoprophylaxis against many important HIV-associated infections is increasing the incidence of other end-stage complications such as cytomegalovirus and disseminated MAC disease. [References: 30]

Publication Type: Journal Article. Review.

<12>

Unique Identifier [PMID]: 16044571

Authors: Laurence J.

Title: HIV and the lung in the HAART era. [Review] [18 refs]

Source: AIDS Reader. 15(7):327, 330, 2005 Jul.

Publication Type: Editorial. Review.

<13>

Unique Identifier [PMID]: 15728594

Authors: Marchiori E. Muller NL. Soares Souza A Jr. Escuissato DL. Gasparetto EL. Franquet T.

Institution: Department of Radiology, Hospital Clementino Fraga, Universidade Federal Fluminense e Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.

Title: Pulmonary disease in patients with AIDS: high-resolution CT and pathologic findings.

Source: AJR. American Journal of Roentgenology. 184(3):757-64, 2005 Mar.

Publication Type: Journal Article.

<14>

Unique Identifier [PMID]: 12226010

Authors: O'Neil KM.

Title: The changing landscape of HIV-related lung disease in the era of highly active antiretroviral therapy.[comment].

Comments Comment on: Chest. 2002 Sep;122(3):878-85; PMID: 12226027

Source: Chest. 122(3):768-71, 2002 Sep.

Publication Type: Comment. Editorial.

<15>

Unique Identifier [PMID]: 11266236

Authors: Martinez Garcia MA. de Rojas MD. Nauffal Manzur MD. Munoz Pamplona MP. Compte Torrero L. Macian V. Perpina Tordera M.

Institution: Department of Pneumology, Hospital Universitario La Fe, Valencia, Spain. med013413@nacom.es

Title: Respiratory disorders in common variable immunodeficiency.

Source: Respiratory Medicine. 95(3):191-5, 2001 Mar.

Abstract: Common variable immunodeficiency (CVID) is a heterogeneous immunodeficiency syndrome characterized by hypogammaglobulinemia, recurrent bacterial infections, and various immunologic abnormalities. The clinical presentation is generally that of recurrent pyogenic sinopulmonary infections. Our objectives were to study the prevalence of lung involvement and the response to intravenous immunoglobulin replacement therapy in 19 patients with CVID. Nineteen patients (12 men) with a mean age (SD) of 33.1 (17.1) years had a previous diagnosis of CVID and were treated with intravenous immunoglobulin replacement. All patients underwent complete pulmonary function tests and high-resolution computed tomography (HRCT) examination. Bronchiectasis was diagnosed in 11 (58%) patients and eight (42%) were multi-lobar bronchiectasis. Chronic airflow limitation (CAL) was present in 10 (53%) patients and a restrictive pattern was seen in one case. Eleven patients (58%) presented a decrease in single-breath carbon monoxide diffusing capacity of the lung (DL(CO)). Before intravenous immunoglobulin replacement therapy (INIRT), 84% of patients had suffered from at least one episode of pneumonia. Episodes of lower respiratory tract infection decreased significantly from 0.28 per patient and year before replacement therapy to 0.16 per patient and year after treatment. The mean duration of replacement therapy was 7.5 years. In conclusion lung involvement was frequent in patients with CVID. Long-term administration of intravenous gammaglobulin resulted in a substantial reduction of pneumonic episodes.

Publication Type: Journal Article.

<16>

Unique Identifier [PMID]: 10812650

Authors: Maki DD.

Institution: Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104, USA.

Title: Pulmonary infections in HIV/AIDS. [Review] [106 refs]

Source: Seminars in Roentgenology. 35(2):124-39, 2000 Apr.

Publication Type: Journal Article. Review.

<17>

Unique Identifier [PMID]: 10638511

Authors: Salzman SH.

Institution: Division of Pulmonary Critical Care Medicine, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, New York 10003, USA.

Title: Bronchoscopic techniques for the diagnosis of pulmonary complications of HIV infection. [Review] [37 refs]

Source: Seminars in Respiratory Infections. 14(4):318-26, 1999 Dec.

Abstract: Bronchoscopy has played the central role in defining the spectrum of pulmonary disorders that occur in patients with HIV infection. Transbronchial biopsy (TBB) and bronchoalveolar lavage (BAL) both have high yields in the diagnosis of Pneumocystis carinii pneumonia (PCP) and other infections. Paradoxically, despite our knowledge and experience using bronchoscopy, controversy still exists regarding whether to attempt to make a bronchoscopic diagnosis in most patients with suspected PCP who have negative sputum studies or whether to administer initial empiric therapy and reserve invasive diagnostic techniques for patients who have a response. I prefer establishing a diagnosis as soon as possible because bronchoscopy is safe and because the patient may not have PCP and may become too ill to have bronchoscopy after a few days of ineffective therapy. A second controversy relates to the necessity of including routine TBB in addition to BAL during bronchoscopy. Although biopsies increase the risk of pneumothorax and hemorrhage, they add to the diagnostic yield in PCP and other infections. They are also necessary to provide tissue specimens for diagnosing noninfectious pulmonary disorders such as Kaposi's sarcoma and lymphocytic and nonspecific pneumonitis. [References: 37]

Publication Type: Journal Article. Review.

<18>

Unique Identifier [PMID]: 9799133

Authors: Haramati LB. Jenny-Avital ER.

Institution: Department of Radiology, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, New York 10467, USA.

Title: Approach to the diagnosis of pulmonary disease in patients infected with the human immunodeficiency virus. [Review] [70 refs]

Source: Journal of Thoracic Imaging. 13(4):247-60, 1998 Oct.

Abstract: Patients infected with the human immunodeficiency virus are predisposed to develop a variety of common and uncommon infectious and neoplastic pulmonary diseases. Clinical information that can stratify the risk of occurrence of these pulmonary conditions includes: 1) CD4 cell count-the most important determinant; 2) concurrent antimicrobial therapy; 3) prior travel history; 4) known latent infections that may reactivate: and 5) underlying respiratory disease. Specific pulmonary diseases are discussed including: bacterial pneumonia, bronchitis, mycobacterial and fungal infections, pneumocystis carinii pneumonia, toxoplasmosis, cytomegalovirus, Kaposi sarcoma, lymphoma, and lung cancer. A differential diagnosis can be generated based on the chest radiographic pattern. Focal or multifocal areas of consolidation usually represent conventional bacterial pneumonia or, less commonly, tuberculosis. In severely immunocompromised patients, unusual diseases causing consolidation should be considered including: Rhodococcus infection, nocardiosis, cryptococcosis, aspergillosis, and lymphoma. Nodules can be present in tuberculosis, histoplasmosis, cryptococcosis, and Kaposi sarcoma. Interstitial opacities are common in pneumocystis carinii pneumonia, histoplasmosis, and cytomegalovirus pneumonia. Cavitation and cysts are features of pneumocystis carinii pneumonia, tuberculosis, aspergillosis, and lung cancer. Disease of the airways is increasingly recognized in those with acquired immunodeficiency syndrome. Lymphadenopathy is most common in mycobacterial infection, but can be a feature of fungal infection, lymphoma, Kaposi sarcoma, and lung cancer. The combined use of clinical information, knowledge of typical conditions associated with the human immunodeficiency syndrome, and radiographic patterns offers a useful approach to the diagnosis of pulmonary disease in the patient with the human immunodeficiency virus. [References: 70]

Publication Type: Journal Article. Review.

<19>

Unique Identifier [PMID]: 9567321

Authors: Shah RM. Salazar AM.

Institution: Department of Radiology, Medical College of Pennsylvania, Philadelphia 19129, USA.

Title: CT manifestations of human immunodeficiency virus (HIV)-related pulmonary infections. [Review] [44 refs]

Source: Seminars in Ultrasound, CT & MR. 19(2):167-74, 1998 Apr.

Abstract: The infectious pulmonary complications of acquired immunodeficiency syndrome (AIDS) are reviewed, with emphasis on the spectrum of CT imaging findings and diagnostic accuracy and limitations as reported in the current literature. Changes in epidemiologic trends for common AIDS-related infections and the associated ranges of CD4 lymphocyte counts, when these infections are typically encountered, are discussed. [References: 44]

Publication Type: Journal Article. Review.

<20>

Unique Identifier [PMID]: 9567320

Authors: Mason AC. Muller NL.

Institution: Department of Radiology, St. Paul's Hospital, Vancouver, BC, Canada.

Title: The role of computed tomography in the diagnosis and management of human immunodeficiency virus (HIV)-related pulmonary diseases. [Review] [74 refs]

Source: Seminars in Ultrasound, CT & MR. 19(2):154-66, 1998 Apr.

Abstract: This review summarizes the current role of CT in the diagnosis and management of respiratory disease in human immunodeficiency virus (HIV)-positive patients. Recommendations are made concerning optimum technique for diagnostic CT as well as practical considerations concerning the use of CT in biopsy and thoracic interventional procedures in acquired immune deficiency syndrome (AIDS)-related thoracic disease. Clinical scenarios discussed include the use of CT when the chest radiograph is normal in a patient with a high clinical suspicion of pulmonary disease, utility of CT in the differential diagnosis of parenchymal abnormalities and in the assessment of patients with airways disease, hemoptysis, progressive lung disease, and intrathoracic complications. Finally, the use of thoracic CT in the staging of AIDS-related neoplastic conditions involving the chest is discussed. [References: 74]

Publication Type: Journal Article. Review.

<21>

Unique Identifier [PMID]: 9298088

Authors: McGuinness G.

Institution: Department of Radiology, New York University Medical Center, New York, USA.

Title: Changing trends in the pulmonary manifestations of AIDS. [Review] [153 refs]

Source: Radiologic Clinics of North America. 35(5):1029-82, 1997 Sep.

Abstract: This article reviews the changing trends observed in AIDS patients over the course of the epidemic. The spectrum of diseases of the chest associated with HIV infection is vast and varied. To generate a useful differential diagnosis based on imaging findings, the radiologist must appreciate shifts in disease prevalence and epidemiology and appreciate changing radiographic manifestations of many of these diseases. Imaging findings, both with chest radiography and CT scan, are summarized and the importance of integration of clinical information in interpreting these images and generating a reasonable differential diagnosis is emphasized. [References: 153]

Publication Type: Journal Article. Review.

<22>

Unique Identifier [PMID]: 8976923

Authors: McGuinness G. Gruden JF. Bhalla M. Harkin TJ. Jagirdar JS. Naidich DP.

Institution: Department of Radiology, New York University Medical Center/Bellevue Hospital, New York, NY 10016, USA.

Title: AIDS-related airway disease. [Review] [61 refs]

Source: AJR. American Journal of Roentgenology. 168(1):67-77, 1997 Jan.

Abstract: To our knowledge, the importance of airway disease in HIV-positive patients has been infrequently noted. This deficit likely reflects a combination of factors including lack of familiarity with recent changes in clinical and epidemiologic patterns of pulmonary manifestations of HIV infection and documented limitations of chest radiography for identifying and differentiating airway disease from other causes of pulmonary disease in HIV-positive patients. Familiarity with the imaging findings for these various entities should facilitate prompt diagnosis and treatment. The accuracy of CT in detecting airway disease [55-59] is well established and should be of value in excluding more common diseases that may be initially confused with airway abnormalities [60, 61]. Small airways disease, in particular, which may be occult or mimic an interstitial infiltrate on chest radiography, can be recognized with CT as likely representing infectious bronchitis or bronchiolitis. Patients with findings suggesting bacterial infections may benefit from empiric antibiotic therapy. CT also may be valuable for differentiating between various noninfectious pulmonary diseases, allowing a presumptive diagnosis of parenchymal Kaposi's sarcoma in the appropriate clinical context. In distinction, by detecting localized endobronchial or parenchymal abnormalities in patients with mycobacterial or fungal infections or lymphoma, CT may be valuable for deciding between various invasive methods of obtaining either histologic or bacteriologic diagnoses. [References: 61]

Publication Type: Journal Article. Review.

<23>

Unique Identifier [PMID]: 8953614

Authors: Klassen MK. Nelson AM.

Institution: Department of Infectious and Parasitic Disease Pathology, Armed Forces Institute of Pathology, Washington, DC 20306, USA.

Title: Recent advances in the pulmonary pathology of human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS). [Review] [149 refs]

Source: Pathology. 4(1):43-71, 1996.

Abstract: Pathology played an important role in the initial recognition of AIDS and continues to be instrumental in the development of case definitions and in the diagnosis of indicator conditions of HIV. This chapter provides an update on HIV and AIDS and discusses the pathologic evaluation of various respiratory conditions in the HIV-infected patient. [References: 149]

Publication Type: Journal Article. Review.

<24>

Unique Identifier [PMID]: 8571866

Authors: Kang EY. Staples CA. McGuinness G. Primack SL. Muller NL.

Institution: Department of Radiology, University of British Columbia, Vancouver, Canada.

Title: Detection and differential diagnosis of pulmonary infections and tumors in patients with AIDS: value of chest radiography versus CT.

Source: AJR. American Journal of Roentgenology. 166(1):15-9, 1996 Jan.

Abstract: OBJECTIVE. The purpose of this study was to compare the sensitivity and specificity of chest radiography with those of CT in the detection of pulmonary infections and tumors in patients with AIDS. MATERIALS AND METHODS. The study was retrospective and included the radiographs and CT scans of 139 patients. Eighty-nine had one proven thoracic complication, 17 had two proven thoracic complications, and 33 had no active intrathoracic disease at the time of the examinations. The radiographs and CT scans were interpreted blindly by two independent observers from different institutions. The observers assessed for the presence or absence of intrathoracic disease and recorded the most likely diagnosis and the degree of confidence in that diagnosis. RESULTS. The patients were more commonly correctly identified as having or not having intrathoracic disease on the basis of CT findings than on the basis of radiographic findings ( p < .01, chi-square test). Of the 106 patients with intrathoracic complications, 90% (191 of 212 interpretations) were correctly identified by the two observers on the radiograph and 96% (204 of 212 interpretations) at CT. Of 33 patients without intrathoracic disease, 73% (48 of 66 interpretations) were correctly identified at radiography and 86% (57 of 66 interpretations) at CT. Of 89 patients with one proved thoracic complication, the observers confident in their first-choice diagnosis in 34% of the cases (61 of 178 interpretations) at chest radiography and in 47% (83 of 178 interpretations) at CT. This diagnosis was correct in 67% (41 of 61) of confident radiographic interpretations as compared with 87% (72 of 83) of interpretations at CT (p < .01, chi-square test). CONCLUSION. CT is superior to chest radiography in allowing identification of patients with and without thoracic disease and in the differential diagnosis of pulmonary complications of patients with AIDS. However, the improvement in differential diagnosis is modest. Because in most cases the radiographs and CT scans were obtained as part of the clinical evaluation, the study is probably biased toward problematic clinical cases. In the majority of patients, the chest radiograph provides adequate information and CT is not warranted.

Publication Type: Journal Article.

<25>

Unique Identifier [PMID]: 9363057

Authors: de Leon FC. Britt EJ.

Institution: University of Maryland Medical Center, Baltimore, USA.

Title: The noninfectious respiratory complications of infection with HIV. [Review] [75 refs]

Source: Current Opinion in Pulmonary Medicine. 1(3):223-33, 1995 May.

Abstract: Infection with HIV was first recognized through a clustering of unusual respiratory infections. The lung has been a major target manifesting many of the infectious complications of the immunodeficiency. Noninfectious pulmonary complications in HIV-infected individuals are also common and have been recognized since the advent of the AIDS epidemic. Malignancies involving the respiratory system, specifically Kaposi's sarcoma and non-Hodgkin's lymphoma, are epidemiologically linked to infection with HIV. Although other cancers have been identified in patients with HIV, these malignancies have a relationship to HIV infection that is unknown. Nonetheless, all cancers in the HIV-infected individual appear to follow a very deadly course. Interstitial pneumonitis and an alveolitis are also seen in individuals infected with HIV. Their relationship to the virus is unknown but may involve the lung's immune response to HIV. Pneumothorax and bullous lung disease are the sequela of pulmonary infections in the HIV-infected host. Pulmonary hypertension has been reported in HIV-infected patients, and like the other noninfectious respiratory complications, the link between the disease process and HIV is unknown. Bronchiectasis is now commonly recognized in AIDS patients who have survived prolonged immunosuppression and infection. Bronchoscopists have accumulated a collection of endobronchial lesions uncommonly seen in non-HIV-related pulmonary consultation. In the following review, we discuss the epidemiology, pathology, pathogenesis, clinical features, diagnostic findings, prognosis, and therapeutic options available for each noninfectious pulmonary complication. As the life expectancy for HIV-infected patients increases, the incidence of noninfectious pulmonary complications will rise. [References: 75]

Publication Type: Journal Article. Review.

<26>

Unique Identifier [PMID]: 7574440

Authors: Dudley A. Boushey HA.

Institution: Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco 94127, USA.

Title: Fifth Seah Cheng Siang Memorial Lecture. Human immunodeficiency virus and the respiratory system--pulmonary manifestations of acquired immunodeficiency syndrome. [Review] [35 refs]

Source: Annals of the Academy of Medicine, Singapore. 24(3):482-9, 1995 May.

Publication Type: Journal Article. Review.

<27>

Unique Identifier [PMID]: 7660346

Authors: Mitchell DM. Miller RF.

Institution: Chest and Allergy Clinic, St Mary's Hospital, London, UK.

Title: AIDS and the lung: update 1995. 2. New developments in the pulmonary diseases affecting HIV infected individuals.[see comment]. [Review] [116 refs]

Comments Comment in: Thorax. 1995 Nov;50(11):1227; PMID: 8553287, Comment in: Thorax. 1996 Feb;51(2):228; PMID: 8711668

Source: Thorax. 50(3):294-302, 1995 Mar.

Publication Type: Journal Article. Review.

<28>

Unique Identifier [PMID]: 10144743

Authors: Medin DL. Ognibene FP.

Institution: Warren G Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA.

Title: Pulmonary disease in AIDS: implications for respiratory care practitioners. [Review] [264 refs]

Source: Respiratory Care. 40(8):832-54, 1995 Aug.

Publication Type: Journal Article. Review.

<29>

Unique Identifier [PMID]: 7774325

Authors: Obregon RG. Lynch DA. Kaske T. Newell JD Jr. Kirkpatrick CH.

Institution: Department of Radiology, National Jewish Center for Immunology and Respiratory Medicine, Denver, USA.

Title: Radiologic findings of adult primary immunodeficiency disorders. Contribution of CT.

Source: Chest. 106(2):490-5, 1994 Aug.

Abstract: STUDY OBJECTIVE: We wished to review the chest radiographic and computed tomographic (CT) findings in adults with primary immunodeficiency disorders, and to evaluate the influence of CT on the treatment of these patients. DESIGN: Retrospective blinded review of radiographs, CT scans, and clinical data. SETTING: National referral center for immunodeficiency disorders. PATIENTS: Forty-six chest radiographs and 22 CT examinations of subjects with primary immunodeficiency disorders were independently scored. Nineteen of the subjects who had CT scans had B-cell deficiency, while 3 had T-cell deficiency. RESULTS: CT-detected bronchiectasis in 15 of 19 subjects with B-cell deficiency, compared with 7 cases detected on chest radiograph. Unsuspected upper lobe bronchiectasis was found on CT in 15 cases. Other CT findings in this group included small nodules in seven subjects, interstitial lines in four, air trapping in seven, ground glass or parenchymal consolidation in nine, evidence of small airways disease in nine, and mucus plugs in four. Two of the three subjects with T-cell disorders showed cavitation and two had unsuspected reactive mediastinal adenopathy. Clinical management appeared to be altered in five subjects with B-cell deficiency by CT findings of severe focal or diffuse bronchiectasis or small airways disease. Additionally, CT localized the bleeding site in three subjects with hemoptysis. CONCLUSIONS: CT is valuable for detection of bronchiectasis in subjects with B-cell immunodeficiency and may alter treatment of these patients.

Publication Type: Journal Article.

<30>

Unique Identifier [PMID]: 7939794

Authors: Kuhlman JE.

Institution: Department of Radiology, Johns Hopkins Outpatient Center, Baltimore, MD 21287.

Title: Pulmonary manifestations of acquired immunodeficiency syndrome. [Review] [101 refs]

Source: Seminars in Roentgenology. 29(3):242-74, 1994 Jul.

Publication Type: Journal Article. Review.

<31>

Unique Identifier [PMID]: 8059005

Authors: Sorice F.

Institution: Istituto di Malattie Infettive, Universita La Sapienza, Roma.

Title: Clinical patterns of HIV-related respiratory disease.

Source: Rays. 19(2):97-103, 1994 Apr-Jun.

Publication Type: Journal Article.

<32>

Unique Identifier [PMID]: 8058993

Authors: Sallustio G. Salvatori M. Natale L. Pirronti T. Saletnich I. Fasanelli L. Macis G.

Institution: Istituto di Radiologia, Universita Cattolica del S. Cuore, Policlinico A. Gemelli, Roma, Italy.

Title: Diagnostic imaging of HIV-related respiratory disease.

Source: Rays. 19(2):104-26, 1994 Apr-Jun.

Publication Type: Journal Article.

<33>

Unique Identifier [PMID]: 8306736

Authors: Nelson RS. Rickman LS. Mathews WC. Beeson SC. Fullerton SC.

Institution: University of California, School of Medicine, San Diego.

Title: Rapid clinical diagnosis of pulmonary abnormalities in HIV-seropositive patients by auscultatory percussion.

Source: Chest. 105(2):402-7, 1994 Feb.

Abstract: A prospective, blinded study of pulmonary findings in hospitalized patients with HIV infection compared auscultatory percussion (AusP) with conventional percussion (ConP) and conventional auscultation (ConA) using chest radiographs as the gold standard. Sixty-three patients had chest radiographs and were examined by one to three examiners. Seventy of the 126 lungs had radiographic abnormalities (55.6 percent). Auscultatory percussion proved to be the most sensitive of all techniques for each examiner (range, 51.0 to 69.6 percent) for detecting radiographic abnormalities and also had higher likelihood ratios for two of the three examiners; AusP also had the highest likelihood ratio pooled across examiners. Of the 166 abnormal results of lung examinations, the combination of AusP and ConA detected 31 more abnormalities than ConP and ConA combined, with 14 of these being diagnosed with Pneumocystis carinii pneumonia. No abnormalities were detected by ConP that were not detected by AusP. These findings suggest that AusP, a rapid clinical maneuver, is more sensitive and specific than ConA and ConP in determining pulmonary abnormalities in HIV-infected inpatients.

Publication Type: Clinical Trial. Controlled Clinical Trial. Journal Article.

<34>

Unique Identifier [PMID]: 8256894

Authors: Wallace JM. Rao AV. Glassroth J. Hansen NI. Rosen MJ. Arakaki C. Kvale PA. Reichman LB. Hopewell PC.

Institution: University of California, Los Angeles.

Title: Respiratory illness in persons with human immunodeficiency virus infection. The Pulmonary Complications of HIV Infection Study Group.

Source: American Review of Respiratory Disease. 148(6 Pt 1):1523-9, 1993 Dec.

Abstract: Although the pulmonary complications of advanced human immunodeficiency virus (HIV) infection have been well described, there is little information on respiratory manifestations of earlier disease. This report describes the respiratory disorders diagnosed over an 18-month period in a cohort of persons with or at risk for HIV infection with variable immunologic status. Cohort members were followed routinely and evaluated for respiratory disease by standard diagnostic algorithms. The 18-month incidence of each respiratory diagnosis was determined, and for frequent diagnoses, incidence by transmission category, location of residence, smoking status, CD4 count, and performance score at entry were compared. The most frequent respiratory diagnoses in HIV-seropositive cohort members were common to the general population: upper respiratory infection (33.4%), acute bronchitis (16.0%), acute sinusitis (5.3%), and bacterial pneumonia (4.8%). Pneumocystis carinii pneumonia occurred in 3.9%. Ambulatory respiratory illnesses were reported frequently regardless of immunologic status. The rates of P. carinii pneumonia and bacterial pneumonia were significantly greater in cohort members with entry CD4 counts < 250. Bacterial pneumonia occurred more frequently in injecting drug users and in cohort members with entry Karnofsky scores < 90. Disease stage and demographic and exposure factors are important variables affecting the respiratory manifestations of HIV infection.

Publication Type: Journal Article. Multicenter Study.

<35>

Unique Identifier [PMID]: 8369787

Authors: Speich R.

Institution: Dept of Internal Medicine, University Hospital of Zurich, Switzerland.

Title: Diagnosis of pulmonary problems in HIV-infected patients. [Review] [86 refs]

Source: Monaldi Archives for Chest Disease. 48(3):221-32, 1993.

Abstract: During the past 13 yrs it has become evident that pulmonary complications occur frequently and are often life-threatening in patients infected with the human immunodeficiency virus (HIV). Moreover, the spectrum of HIV-related pulmonary diseases has enlarged considerably and it now includes numerous infectious and non-infectious conditions. Because clinical and radiological presentation is generally nonspecific and often altered by diminished signs of inflammation or prophylactic measures, and multiple simultaneous complications frequently occur, an early aetiological diagnosis is essential. The diagnostic work-up of these patients must be straightforward. Examination of (induced) sputum and bronchoalveolar lavage fluid are the most important procedures. If they are not diagnostic, transbronchial biopsy, transbronchial needle aspiration, computed tomography and echocardiography are most often revealing. However, we must be continuously prepared to face new complications in the course of this devastating disease. [References: 86]

Publication Type: Journal Article. Review.

<36>

Unique Identifier [PMID]: 8102043

Authors: Kvale PA. Rosen MJ. Hopewell PC. Markowitz N. Hansen N. Reichman LB. Wallace JM. Glassroth J. Fulkerson W. Meiselman L.

Institution: Division of Pulmonary & Critical Care Medicine, Henry Ford Hospital, Detroit, MI 48202-2689.

Title: A decline in the pulmonary diffusing capacity does not indicate opportunistic lung disease in asymptomatic persons infected with the human immunodeficiency virus. Pulmonary Complications of HIV Infection Study Group.

Source: American Review of Respiratory Disease. 148(2):390-5, 1993 Aug.

Abstract: We enrolled 1,353 subjects in a multicenter study to evaluate the spectrum of pulmonary complications associated with human immunodeficiency virus (HIV) infection and the feasibility of detecting pulmonary infections in asymptomatic members of this group. There were 1,171 who were HIV-seropositive; the remaining 182 were HIV-seronegative, but they belonged to high-risk transmission groups (homosexual/bisexual, or injection drug users). Single-breath carbon monoxide diffusing capacity (DLCO) was measured serially (at 3- to 12-month intervals) in a prospective fashion to determine whether a decline of > or = 20% predicted the presence of Pneumocystis carinii pneumonia or other pulmonary infections in the absence of new pulmonary symptoms and no new abnormalities on chest roentgenograms. In 64 subjects (6% of the group who had two or more measurements) DLCO declined > or = 20% from a prior value within 2 yr of entry, unassociated with fever, increased cough or dyspnea, or new chest roentgenogram abnormalities. Induced sputum was analyzed for the presence of P. carinii and mycobacteria in 44; fiberoptic bronchoscopy was performed with bronchoalveolar lavage in 14, six of whom also had transbronchial lung biopsy. All 64 subjects with the asymptomatic decline in DLCO were followed for an additional 3 to 12 months with additional clinical evaluations, chest roentgenograms, and DLCO determinations, or until death (one subject). In no case was the decline in DLCO due to P. carinii pneumonia or other pulmonary infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Publication Type: Journal Article. Multicenter Study.

<37>

Unique Identifier [PMID]: 8419749

Authors: Pigott P. Smith A. Mills J.

Institution: Department of Thoracic Medicine, Royal North Shore Hospital, St Leonards, NSW.

Title: HIV-related respiratory disease. [Review] [15 refs]

Source: Medical Journal of Australia. 158(2):101-3, 1993 Jan 18.

Abstract: The lungs are a primary target for the opportunistic infections and malignancies affecting those with HIV infection. In the patient whose HIV infection is undiagnosed, PCP is the commonest clue to its presence. Early diagnosis prevents morbidity and mortality. Less commonly, interstitial lung disease and tuberculosis, often "primary" or clinically atypical, will be the clue to underlying HIV infection. Other pulmonary complications are usually a late manifestation of HIV infection, which has usually (but not always) already been diagnosed. [References: 15]

Publication Type: Case Reports. Journal Article. Review.

<38>

Unique Identifier [PMID]: 1417282

Authors: Trachiotis GD. Hafner GH. Hix WR. Aaron BL.

Institution: Division of Cardiothoracic Surgery, George Washington University Medical Center, Washington, DC 20037.

Title: Role of open lung biopsy in diagnosing pulmonary complications of AIDS.

Source: Annals of Thoracic Surgery. 54(5):898-901; discussion 902, 1992 Nov.

Abstract: Over a 4-year period, 25 patients with pulmonary complications of acquired immunodeficiency syndrome underwent open lung biopsy for diagnosis. Results of the biopsy led to a change in therapy in 15, and of this group, 8 patients improved clinically and were discharged. We believe that a select group of acquired immunodeficiency syndrome patients with pulmonary disease will benefit from open lung biopsy. Our indications for open lung biopsy are (1) a nondiagnostic bronchoscopy, (2) failed medical therapy after a diagnostic bronchoscopy, (3) failed empiric medical therapy after a nondiagnostic bronchoscopy or after a second nondiagnostic bronchoscopy, and (4) when any of the forementioned are accompanied with a worsening chest roentgenogram. Patients with acquired immunodeficiency syndrome who have a deteriorating respiratory status or require mechanical ventilation should not undergo open lung biopsy.

Publication Type: Journal Article.

<39>

Unique Identifier [PMID]: 1571469

Authors: Meduri GU. Stein DS.

Institution: Division of Pulmonary and Critical Care Medicine, University of Tennessee Medical Center, Memphis.

Title: Pulmonary manifestations of acquired immunodeficiency syndrome. [Review] [153 refs]

Source: Clinical Infectious Diseases. 14(1):98-113, 1992 Jan.

Abstract: In at least 65% of patients with acquired immunodeficiency syndrome (AIDS), the lung is the site for life-threatening illness. To establish a basis for understanding the pulmonary pathology of such illness, we first review briefly the effects of the human immunodeficiency virus on the immune system and then review the pathological pulmonary processes occurring in AIDS in terms of their various etiologies: infections, idiopathic processes, and neoplasia. In the section on each etiology, we discuss clinical manifestations, pulmonary pathology, diagnostic findings, and therapeutic options. In the last section, we outline our overall initial diagnostic approach to the patient with AIDS who presents with respiratory symptoms, and we discuss the integration of clinical, laboratory, and radiographic findings. [References: 153]

Publication Type: Journal Article. Review.

<40>

Unique Identifier [PMID]: 1889255

Authors: Carson PJ. Goldsmith JC.

Institution: Department of Medicine, University of Nebraska Medical Center, Omaha.

Title: Atypical pulmonary diseases associated with AIDS.

Source: Chest. 100(3):675-7, 1991 Sep.

Abstract: We present three patients with pulmonary diseases not usually associated with AIDS. Early recognition and treatment allowed a favorable outcome. The cases are discussed and the literature is reviewed.

Publication Type: Case Reports. Journal Article.

<41>

Unique Identifier [PMID]: 1871267

Authors: Naidich DP. McGuinness G.

Institution: Department of Radiology, New York University Medical Center-Bellevue Hospital, New York.

Title: Pulmonary manifestations of AIDs. CT and radiographic correlations. [Review] [83 refs]

Source: Radiologic Clinics of North America. 29(5):999-1017, 1991 Sep.

Abstract: To date, few reports have attempted to correlate plain radiographic findings with computed tomography (CT) in assessing pulmonary disease in patients who have acquired immunodeficiency syndrome (AIDS). This report focuses on the most common pulmonary manifestations, with particular emphasis placed on those entities for which there is a potential role for CT. This includes identification of occult disease, especially the early diagnosis of Pneumocystis carinii pneumonia, as well as identification of unsuspected lung abscesses and cavities; characterization of diffuse parenchymal disease in patients who have abnormal radiographs; identification and characterization of mediastinal lymphadenopathy, especially in differentiating between neoplastic and non-neoplastic causes; and finally, use of CT to perform CT-guided transthoracic needle biopsies. [References: 83]

Publication Type: Journal Article. Review.

<42>

Unique Identifier [PMID]: 1871266

Authors: Moore EH.

Institution: Department of Radiology, Harvard Medical School, Boston, Massachusetts.

Title: Diffuse lung disease in the current spectrum of immunocompromised hosts (non-AIDS). [Review] [90 refs]

Source: Radiologic Clinics of North America. 29(5):983-97, 1991 Sep.

Abstract: Diffuse lung disease occurring in an immunocompromised patient is a nonspecific finding that may result from one or more of a variety of infectious and noninfectious causes. Patient history and clinical information are essential in narrowing the differential diagnosis, but in most patients, diagnostic procedures must be performed to determine appropriate therapy. Diagnostic possibilities include infection, spread of malignancy, reactions to chemotherapy or radiation, nonspecific interstitial pneumonitis, hemorrhage, and unrelated medical conditions. An understanding of the specific nature of the patient's immunologic defect and underlying disease allows one to predict the most likely organisms in cases of infection. [References: 90]

Publication Type: Journal Article. Review.

<43>

Unique Identifier [PMID]: 1859769

Authors: Goodman PC.

Institution: San Francisco General Hospital, California.

Title: The chest film in the acquired immunodeficiency syndrome. [Review] [33 refs]

Source: Current Opinion in Radiology. 3(3):357-63, 1991 Jun.

Abstract: This paper is a selective review of the past year's literature on the infections and neoplasms that develop in patients with the acquired immunodeficiency syndrome. In general, the recent literature supports information previously reported and includes further suggestions about the pathogenesis of findings seen on chest radiographs. [References: 33]

Publication Type: Journal Article. Review.

<44>

Unique Identifier [PMID]: 2026243

Authors: Semenzato G.

Institution: Padua University School of Medicine, Dept of Clinical Medicine, Italy.

Title: Immunology of interstitial lung diseases: cellular events taking place in the lung of sarcoidosis, hypersensitivity pneumonitis and HIV infection. [Review] [42 refs]

Source: European Respiratory Journal. 4(1):94-102, 1991 Jan.

Abstract: This paper summarizes our research and the results obtained on the topic of immunology of interstitial lung disorders. Areas of investigation mainly included sarcoidosis, hypersensitivity pneumonitis (HP), and more recently the pulmonary involvement in acquired immunodeficiency syndrome (AIDS). In sarcoidosis patients two major mechanisms account for the alveolitis, i.e. an in situ cellular proliferation and a cellular redistribution from the peripheral blood to the sites of disease activity, including the lung. These findings involve both lymphocytes (CD4 helper-related cells) and macrophages, and lead to the formation and provide maintenance of sarcoid granuloma. In patients with hypersensitivity pneumonitis the lung infiltrates are characterized by cells bearing suppressor/cytotoxic phenotype. The expansion of cells with these characteristics in the lung of these patients is likely to be related to a local immune response to the antigenic stimulus. In the lung of patients with AIDS we also found a discrete lymphocytic alveolitis bearing the CD8 cytotoxic-related phenotype. The role of cytotoxic events, related to the lymphocytes and macrophages, which are operative in the lung of AIDS patients, is being evaluated. The analysis of cells recovered from the lavage, mainly lymphocytes and macrophages, in terms of surface phenotype, functional in vitro evaluations and molecular analysis, has provided new insights into the pathogenesis of the above quoted interstitial lung disorders. [References: 42]

Publication Type: Journal Article. Review.

<45>

Unique Identifier [PMID]: 2240021

Authors: Weissler JC. Mootz AR.

Institution: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.

Title: Pulmonary disease in AIDS patients. [Review] [158 refs]

Source: American Journal of the Medical Sciences. 300(5):330-43, 1990 Nov.

Abstract: Pulmonary disease remains a major complication of the human immunodeficiency virus (HIV). Over the past decade several changes in the pattern of disease have occurred. Pneumocystis carinii pneumonia (PCP) remains the most common opportunistic pathogen in AIDS patients, though its incidence on bronchoscopy has declined and empiric therapy often occurs without a specific diagnosis. Changes in the management of patients with PCP have included different dosages and routes of administration for chemotherapy, improved overall survival, and a recent increase in the number of patients surviving episodes of respiratory failure. In addition, infection with mycobacteria tuberculosis (M.Tb.) has emerged as a major public health problem. The pattern of M.Tb. is distinct from non-immunocompromised patients though response to therapy usually occurs. [References: 158]

Publication Type: Journal Article. Review.

<46>

Unique Identifier [PMID]: 2198162

Authors: Ognibene FP.

Institution: Critical Care Medicine Department, Warren G, Magnuson Clinical Center, National Institutes of Health, Bethesda, MD.

Title: Upper and lower airway manifestations of human immunodeficiency virus infection. [Review] [47 refs]

Source: Ear, Nose, & Throat Journal. 69(6):424-31, 1990 Jun.

Abstract: Patients with HIV infection can have a variety of infectious, neoplastic, and noninfectious but inflammatory processes that involve their upper or lower airways. Knowledge of these pathologic processes as well as a suitable diagnostic approach are essential to care effectively for these patients. [References: 47]

Publication Type: Journal Article. Review.

<47>

Unique Identifier [PMID]: 2187388

Authors: Murray JF. Mills J.

Institution: Pulmonary Division, San Francisco General Hospital Medical Center, California.

Title: Pulmonary infectious complications of human immunodeficiency virus infection. Part I. [Review] [191 refs]

Source: American Review of Respiratory Disease. 141(5 Pt 1):1356-72, 1990 May.

Publication Type: Journal Article. Review.

<48>

Unique Identifier [PMID]: 2181720

Authors: Miller RF. Leigh TR. Collins JV. Mitchell DM.

Institution: University College, London.

Title: AIDS and the lung. 5--Tests giving an aetiological diagnosis in pulmonary disease in patients infected with the human immunodeficiency virus.[see comment]. [Review] [51 refs]

Comments Comment in: Thorax. 1990 Oct;45(10):777; PMID: 2247873, Comment in: Thorax. 1991 Feb;46(2):150; PMID: 2014502

Source: Thorax. 45(1):62-5, 1990 Jan.

Publication Type: Journal Article. Review.

<49>

Unique Identifier [PMID]: 2181719

Authors: Millar AB. Mitchell DM.

Institution: Department of Medicine, University College and Middlesex School of Medicine, London.

Title: AIDS and the lung. 4-- Non-invasive investigation of pulmonary disease in patients positive for the human immunodeficiency virus.[see comment]. [Review] [59 refs]

Comments Comment in: Thorax. 1990 Oct;45(10):777; PMID: 2247873

Source: Thorax. 45(1):57-61, 1990 Jan.

Publication Type: Journal Article. Review.

<50>

Unique Identifier [PMID]: 2562248

Authors: Golden JA.

Institution: School of Medicine, University of California, San Francisco.

Title: Pulmonary complications of AIDS. [Review] [214 refs]

Source: Immunology Series. 44:403-47, 1989.

Publication Type: Journal Article. Review.

<51>

Unique Identifier [PMID]: 2701508

Authors: Goodman PC.

Institution: Department of Radiology, San Francisco General Hospital, California.

Title: The chest radiograph in acquired immunodeficiency syndrome. [Review] [23 refs]

Source: Current Opinion in Radiology. 1(1):31-3, 1989 Jun.

Publication Type: Journal Article. Review.

<52>

Unique Identifier [PMID]: 2690709

Authors: White DA. Matthay RA.

Institution: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.

Title: Noninfectious pulmonary complications of infection with the human immunodeficiency virus. [Review] [247 refs]

Source: American Review of Respiratory Disease. 140(6):1763-87, 1989 Dec.

Publication Type: Journal Article. Review.

<53>

Unique Identifier [PMID]: 2689064

Authors: Marcy TW. Reynolds HY.

Institution: Section of Pulmonary and Critical Care Medicine, University of Minnesota Medical School, Minneapolis.

Title: Pulmonary consequences of congenital and acquired primary immunodeficiency states. [Review] [93 refs]

Source: Clinics in Chest Medicine. 10(4):503-19, 1989 Dec.

Abstract: A sophisticated system of pulmonary host defense strives to maintain the functional integrity of the lung against the threats of infections, toxins, and malignancy. Congenital and acquired defects in the immune mechanisms of this host defense are associated with a variety of pulmonary disorders that include infections with usual or opportunistic organisms; inflammatory disorders; and malignancies. The age of the patient, associated abnormalities, family history, and the type of pulmonary and systemic diseases that are present provide clues to the specific underlying disorder. Laboratory tests including immunoglobulin levels, lymphocyte subset enumeration, and tests of lymphocyte function can help to confirm the clinical impression. Determination of the specific disorder allows the physician to anticipate possible complications, initiate appropriate prophylactic measures, and, in an increasing number of diseases, offer specific therapy. [References: 93]

Publication Type: Journal Article. Review.

<54>

Unique Identifier [PMID]: 2685952

Authors: Mitchell DM.

Institution: Department of Medicine, St Mary's Hospital, London, U.K.

Title: Diagnostic problems in AIDS and the lung. [Review] [54 refs]

Source: Respiratory Medicine. 83(1):9-14, 1989 Jan.

Abstract: Since the first case of AIDS in the United Kingdom was described in 1981 (1), there have been up to October 1988, 1794 AIDS cases reported, of whom 965 are dead and 8794 individuals known to be Human Immunodeficiency Virus (HIV) seropositive (2). In fact the actual number of seropositive individuals is likely to be far greater than this figure. A recent study of an HIV seropositive cohort suggests that the majority of individuals infected with HIV will eventually develop AIDS (3). Most of the cases in the U.K. have occurred in homo- or bisexual men, and the pattern of disease in the U.K. closely follows that of the epidemic in the United States. The association between AIDS and infection with HIV was demonstrated in 1983-4 (4,5) and HIV induced damage to the immune system with profound depression of cell mediated immunity is responsible for many of the manifestations of this extraordinary new disease (6). As the lung is the most frequently affected organ in AIDS (7), and as case numbers are likely to increase in the U.K., if the epidemic trend continues, Respiratory Physicians in the U.K. will be increasingly involved in the management of these patients. The purpose of this review is to highlight some of the diagnostic problems encountered in AIDS patients with lung disease. [References: 54]

Publication Type: Journal Article. Review.

<55>

Unique Identifier [PMID]: 2655853

Authors: Edelson JD. Hyland RH.

Institution: Department of Medicine, St. Michael's hospitals.

Title: Pulmonary complications of AIDS: a clinical strategy. [Review] [114 refs]

Source: CMAJ Canadian Medical Association Journal. 140(11):1281-7, 1989 Jun 1.

Abstract: Infectious and noninfectious forms of pulmonary disease are the most common complications of acquired immune deficiency syndrome (AIDS), and many are amenable to treatment. We describe the clinical and radiologic features of the most common causes of lung disease in AIDS patients and review the drugs available for treatment. In addition, we provide a strategy for the clinical assessment and management of patients with human immunodeficiency virus infection who have lung infiltrates. [References: 114]

Publication Type: Journal Article. Review.

<56>

Unique Identifier [PMID]: 3044685

Authors: Clement MJ. Luce JM. Hopewell PC.

Institution: University of California, San Francisco.

Title: Diagnosis of pulmonary diseases. [Review] [46 refs]

Source: Clinics in Chest Medicine. 9(3):497-505, 1988 Sep.

Abstract: A broad spectrum of lung disease occurs in association with HIV infection. Included are both infectious and neoplastic processes and idiopathic disorders. To insure prompt, accurate, and efficient diagnosis, a logical, staged sequence of tests should be applied. Chest films and, in some instances, pulmonary function tests and gallium-67 citrate lung scans serve to provide objective indications of lung disease. Each of these tests is sensitive but nonspecific. Specific infecting organisms, particularly P. carinii, can be identified by examining sputum induced by inhalation of 3 per cent saline. Bronchoscopic procedures, including BAL and TBB, are highly sensitive and should be performed in patients having nondiagnostic sputum examinations. Tests involving antigen and antibody detection are of little use in the evaluation of individual patients. Detection of recurrent episodes of PCP is difficult because abnormalities in the usual screening tests may be residual from previous episodes. Finding P. carinii in sputum or bronchoscopic specimens soon (within 2 to 3 months) after a confirmed episode of PCP likely represents residual organisms rather than recrudescence of the infection. Empiric diagnosis of P. carinii should be employed only in limited circumstances when specific diagnostic studies are not available, are contraindicated, or are refused. [References: 46]

Publication Type: Journal Article. Review.

<57>

Unique Identifier [PMID]: 3282587

Authors: Millar AB.

Institution: Middlesex Hospital, London.

Title: Respiratory manifestations of AIDS. [Review] [82 refs]

Source: British Journal of Hospital Medicine. 39(3):204-15, 1988 Mar.

Abstract: Respiratory disorders are present in at least 40% of patients with the acquired immunodeficiency syndrome (AIDS) and are the commonest mode of presentation. Lung pathology ranges from infections, both opportunistic and non-opportunistic, to Kaposi's sarcoma and lymphoid interstitial pneumonia. AIDS-related lung problems must increasingly be considered in the differential diagnosis of the breathless patient. [References: 82]

Publication Type: Journal Article. Review.