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Approach to the HIV-infected patient with pulmonary symptoms

Author
Diane E Stover, MD
Section Editors
John G Bartlett, MD
Talmadge E King, Jr, MD
Deputy Editor
Jennifer Mitty, MD, MPH

INTRODUCTION

The acquired immunodeficiency syndrome (AIDS) epidemic remains one of the most important global health problems of the 21st century [1-4].

However, the incidence of AIDS-related opportunistic infections (OIs) declined dramatically in the United States and Europe following the clinical development of potent antiretroviral therapy (ART). Despite these gains, pulmonary disease remains a significant cause of morbidity and mortality [5-7]. (See "Selecting antiretroviral regimens for the treatment-naïve HIV-infected patient".)

Just as the pulmonary disorders associated with HIV infection have changed in the 21st century, the approach to the diagnosis of pulmonary disease has evolved as well (figure 1). The clinical assessment of pulmonary symptoms in HIV-infected patients will be reviewed here; specific conditions and their management are discussed separately. (See appropriate topic reviews).

Pulmonary diseases and HIV — The spectrum of pulmonary disease in patients with HIV has changed over the past decades [5-8]. Although Pneumocystis carinii (jirovecii) pneumonia (PCP) remains the most common AIDS-defining OI in the United States, its incidence has decreased with improved prophylactic and antiretroviral therapy. (See "Clinical presentation and diagnosis of Pneumocystis pulmonary infection in HIV-infected patients".)

HIV-infected patients are at risk for a number of other pulmonary infections in addition to PCP. The data on the incidence of bacterial pneumonia in the HAART era are mixed [9] (see "Bacterial pulmonary infections in HIV-infected patients"). However, bacterial pneumonia remains a common complication in HIV-infected patients and has increased as a proportion of diagnosed pulmonary infections despite an overall decrease in the number of cases, as illustrated by the following [10]:

                             

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