Human Immunodeficiency Virus (HIV)

Epidemiology

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Clinical

Pulmonary Manifestations

HIV-Associated Pulmonary Hypertension (see Pulmonary Hypertension, [[Pulmonary Hypertension]])

  • Pulmonary HTN occurs in 0.06-2% of HIV patients and is associated with increased HIV mortality [JAMA 2008;299:324-331]
  • Prevalence of HIV-assocuated pulmonary HTN is not associated with CD4 count
  • Pulmonary arterial hypertension is a rare but well-established complication of HIV infection (32,33)
  • Epidemiologic data in the early 1990s, a time when therapy with highly active antiretroviral therapy was not yet available, indicated a prevalence of 0.5% (95% confidence interval: 0.10% to 0.50%) (34)
  • The prevalence of HIV-associated PAH was evaluated more recently and showed a stable prevalence of 0.46% (95% confidence interval: 0.32% to 0.64%) (35)
  • Human immunodeficiency virus-associated PAH has clinical, hemodynamic, and histologic characteristics similar to those seen in IPAH
    • The mechanism for the development of PH remains unclear. Because neither the virus nor viral DNA has been found in pulmonary endothelial cells, an indirect action of virus through secondary messengers such as cytokines, growth factors, endothelin, or viral proteins is strongly suspected.
  • Uncontrolled studies suggest that patients with severe HIV-associated PAH could benefit from bosentan or long- term infusion of epoprostenol (36,37). Interestingly, in a substantial number of cases, normalization of pulmonary vascular hemodynamics can be obtained with therapy indi- cated for PAH; this is very rarely seen in IPAH (38).

HIV-Associated Pulmonary Veno-Occlusive Disease (see Pulmonary Veno-Occlusive Disease, [[Pulmonary Veno-Occlusive Disease]])

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HIV-Associated Pulmonary Alveolar Proteinosis (see Pulmonary Alveolar Proteinosis, [[Pulmonary Alveolar Proteinosis]])

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HIV-Associated Cryptogenic Organizing Pneumonia (see Cryptogenic Organizing Pneumonia, [[Cryptogenic Organizing Pneumonia]])

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HIV-Associated Pleural Effusion (see Pleural Effusion-Exudate, [[Pleural Effusion-Exudate]])

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HIV-Associated Lymphocytic Interstitial Pneumonia (see Lymphocytic Interstitial Pneumonia, [[Lymphocytic Interstitial Pneumonia]])

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HIV-Associated Pulmonary Infiltrates with Eosinophilia (seePulmonary Infiltrates with Eosinophilia, [[Pulmonary Infiltrates with Eosinophilia]])

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Dermatologic Manifestations

Other Manifestations

Acute HIV Seroconversion

  • Fever (see Fever)
  • Lymphadenopathy

References

  • 32 Kim KK, Factor SM. Membranoproliferative glomerulonephritis and plexogenic pulmonary arteriopathy in a homosexual man with ac- quired immunodeficiency syndrome. Hum Pathol 1987;18:1293– 6.
  • 33 Mehta NJ, Khan IA, Mehta RN, Sepkowitz DA. HIV-related pulmonary hypertension: analytic review of 131 cases. Chest 2000; 118:1133– 41.
  • 34 Opravil M, Pechère M, Speich R, et al. HIV-associated primary pulmonary hypertension: a case control study. Swiss HIV Cohort Study. Am J Respir Crit Care Med 1997;155:990–5.
  • 35 Sitbon O, Lascoux-Combe C, Delfraissy JF, et al. Prevalence of HIV-related pulmonary arterial hypertension in the current antiret- roviral therapy era. Am J Respir Crit Care Med 2008;177:108–13.
  • 36 Nunes H, Humbert M, Sitbon O, et al. Prognostic factors for survival in human immunodeficiency virus-associated pulmonary arterial hy- pertension. Am J Respir Crit Care Med 2003;167:1433–9.
  • 37 Sitbon O, Gressin V, Speich R, et al. Bosentan for the treatment of human immunodeficiency virus-associated pulmonary arterial hyper- tension. Am J Respir Crit Care Med 2004;170:1212–7.
  • 38 Degano B, Yaïci A, Le Pavec J, et al. Long-term effects of bosentan in patients with HIV-associated pulmonary arterial hypertension. Eur Respir J 2008;33:92– 8.
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