REVIEWS   

Minerva Pneumologica 2004 March;43(1):1-30

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English, Italian

The changing spectrum of respiratory infections in HIV-1 infected patients in the era of highly active antiretroviral therapy

Ripamonti D., Ravasio L.

The progressive damage to the immune system caused by chronic HIV-1 infection is measured by the CD4+ cell count decline and it is associated with a high risk of opportunistic diseases and malignancies. Respiratory infections have been one of the major causes of morbidity and hospitalizations in HIV-1 infected individuals since the beginning of the AIDS epidemic. In the late 90s, the introduction of potent combination therapies (also known as highly active antiretroviral therapy, HAART) against HIV-1 has dramatically reduced both morbidity and mortality in this population, mostly through a substantial immune recovery. Nonetheless, respiratory infections are still leading complications particularly in individuals with undiagnosed or untreated HIV-1 infection, or with a severely impaired immune system despite HIV treatment. Common and opportunistic pathogens play a different role according to different settings. The immune recovery following the introduction of new HIV therapies may strongly influence both the presentation and course of intrathoracic diseases. The ''immune reconstitution syndrome'' along with non-infectious causes of pulmonary diseases in this population may complicate the diagnostic scenario. We review the intrathoracic diseases in HIV infected individuals to call the attention of clinicians to the changing spectrum and possible atypical course of pulmonary diseases in the HAART era.