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A Journal on Diseases of the Respiratory System
Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Minerva Pneumologica 2009 June;48(2):145-64
Respiratory infections in HIV positive patients
Premchand N., Ong E.
Department of Infection and Tropical Medicine Newcastle General Hospital Newcastle upon Tyne, UK
Respiratory symptoms are a common feature of illnesses among HIV-infected individuals and may be caused by a wide spectrum of diseases. The spectrum of pulmonary diseases in HIV-infected patients includes both HIV-related and non-HIV-related conditions. The HIV-associated pulmonary conditions include both opportunistic infections (OIs) and neoplasms. The OIs most commonly involve bacterial, mycobacterial, fungal, viral, and parasitic pathogens. Each of these OIs and neoplasms has a characteristic clinical and radiographic presentation. However, there is considerable variation and overlap in these presentations. Therefore, no constellation of symptoms, physical examination findings, laboratory abnormalities, and chest radiographic findings is pathognomonic or specific for a particular disease. A definitive microbiologic or pathologic diagnosis is preferable to empiric therapy whenever possible. Diagnostic tests include blood cultures, specific staining from sputum obtained by induction, serological testing and other respiratory specimens obtained by invasive procedures such as bronchoscopy, thoracentesis, computed tomography-guided transthoracic needle aspiration, thoracoscopy, mediastinoscopy, and at times open-lung biopsy depending on the clinical presentation. This review describes the spectrum of pulmonary illnesses that can affect HIV-infected patients, and a diagnostic approach to the evaluation of respiratory symptoms in HIV-infected patients, highlighting key features of the clinical presentation that may be useful in differentiating the most common OIs and neoplasms.