Clinics in chest medicine
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Clinics in chest medicine · Jun 2013
ReviewImpact of antiretroviral therapy on lung immunology and inflammation.
Human immunodeficiency virus (HIV) infection causes profound changes in the lung compartment characterized by macrophage and lymphocyte activation, secretion of proinflammatory cytokines and chemokines, and accumulation of CD8 T cells in the alveolar space, leading to lymphocytic alveolitis. Because many of the changes seen in the lung can be attributed to the direct effect of HIV on immune cells, therapy to reduce the HIV burden should have significant beneficial effects. Indeed, antiretroviral therapy rapidly reduces the viral burden in the lung, number of CD8 T cells in the alveolar space, and amount of proinflammatory cytokines and chemokines in bronchoalveolar lavage.
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Clinics in chest medicine · Jun 2013
ReviewHuman immunodeficiency virus-associated tuberculosis: update on prevention and treatment.
Tuberculosis (TB) is the leading cause of opportunistic infection and mortality among HIV-infected persons. Screening for symptoms of TB in people with HIV infection, use of isoniazid preventive therapy for those with latent TB infection, earlier diagnosis and treatment of active TB disease, and early initiation of antiretroviral therapy are essential for controlling the spread of TB. Treatment of HIV-related TB is complicated by overlapping drug toxicities and drug-drug interactions between antiretroviral therapy and anti-TB therapy and risk for development of immune reconstitution inflammatory disease. This review provides an overview of the prevention and treatment of TB in HIV-infected persons.
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Clinics in chest medicine · Jun 2013
ReviewPneumocystis pneumonia associated with human immunodeficiency virus.
Pneumocystis pneumonia (PCP) is caused by the yeastlike fungus Pneumocystis. Despite the widespread availability of specific anti-Pneumocystis prophylaxis and of combination antiretroviral therapy (ART), PCP remains a common AIDS-defining presentation. PCP is increasingly recognized among persons living in Africa. ⋯ Trimethoprim-sulfamethoxazole remains the preferred first-line treatment regimen. In the era of ART, mortality from PCP is approximately 10% to 12%. The optimal time to start ART in a patient with PCP remains uncertain.
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Clinics in chest medicine · Jun 2013
ReviewFuture directions: lung aging, inflammation, and human immunodeficiency virus.
Chronic lung diseases, including chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH), are unusually prevalent among persons infected with human immunodeficiency virus (HIV). Often these disease states are identified at younger ages than would be expected in the general population. Recent epidemiologic, basic scientific, and cross-sectional clinical data have implicated immune dysfunction and cellular senescence as potential drivers of advanced presentations of age-related diseases in HIV-infected persons. This article describes how HIV-associated COPD and PH may fit into a paradigm of immunosenescence, and outlines the hypothesized associations among chronic HIV infection, immune dysfunction and senescence, and cardiopulmonary outcomes.
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Clinics in chest medicine · Jun 2013
ReviewHuman immunodeficiency virus-associated lung malignancies.
This review of lung malignancies in human immunodeficiency virus (HIV) briefly highlights key epidemiologic and clinical features in the pulmonary involvement of AIDS-defining malignancies of Kaposi sarcoma and non-Hodgkin lymphoma. Then, focusing on non-AIDS defining lung cancer, the epidemiology and mechanisms, clinical presentation, pathology, treatment and outcomes, and prevention of HIV-associated lung cancer are discussed. Finally, the important knowledge gaps and future directions for research related to HIV-associated lung malignancies are highlighted.