Respiratory Tract Infections in Patients with HIV Infection

Respiratory complaints amongst people with HIV infection are common with a wide range of aetiologies, although the majority will be caused by common viral or bacterial infections. This chapter aims to cover the spectrum of bacterial, fungal and viral organisms, with an emphasis on a diagnostic approach and treatment. Mycobacterial and cryptococcal infections will be covered elsewhere.

The approach to respiratory disease in patients with HIV involves a synthesis of symptoms, signs, epidemiological risk factors, knowledge of the patient’s degree of immunodeficiency, chest radiography and sputum sampling. More specialised investigations such as lung-function testing, computed tomography (CT) of the chest, bronchoscopy or lung biopsy may be required to make a diagnosis. Multiple disease processes may affect the respiratory system in human immunodeficiency virus (HIV) infection (Table 1) and multiple pathological processes can occur simultaneously, especially in advanced immunodeficiency.

Opportunistic infections and cancers of the respiratory tract no longer predominate as the cause of respiratory symptoms in the era of combination antiretroviral therapy (cART) and trimethoprim-sulphmethoxazole prophylaxis, with great reductions in the incidence of Pneumocystis jiroveci pneumonia and bacterial pneumonia.1.Non-infective respiratory disorders such as chronic airflow limitation and lung cancer may be increasing, as survival improves.2 It is important therefore to consider the differential diagnosis of symptoms according to level of immunodeficiency and treatment with cART. The onset of respiratory symptoms after the initiation of cART in an immunocompromised patient suggests the possibility of an immune reconstitution inflammatory syndrome.2