Although opportunistic infections and cancers of the lung were among the most common causes of death for people with HIV in the past, highly active antiretroviral therapy (HAART) has greatly improved the prognosis. However, respiratory problems still remain a frequent complaint in people with HIV.
The general symptoms of opportunistic infections and cancers affecting the lung are:
Associated symptoms can include fever, night sweats, chills, fatigue, lack of appetite, headache and weight loss. Any HIV-positive person with these symptoms should have them promptly checked out by a doctor.
HIV can result in many kinds of opportunistic infections that affect the lungs. Here are some of the most significant:
- Tuberculosis. Although anyone can develop active tuberculosis, immunocompromised people are at a much greater risk. The Centers for Disease Control and Prevention (CDC) recommends that everyone who tests positive for HIV have a skin test to determine if they have been exposed to tuberculosis. If the skin test is positive, but you don't have an active infection, your doctor will probably suggest that you take antibiotics for several months to decrease your risk of developing active tuberculosis. This treatment usually consists of isoniazid daily or twice a week for nine months. An alternative is rifampin for four months. However, rifampin is only used in select circumstances because it has many drug interactions, and TB can rapidly develop resistance to it. Chronic maintenance therapy is not necessary to prevent the development of active TB.
- Bacterial infections. Bacterial lung infections, especially pneumonia, are among the most common lung ailments in people with HIV. Bronchitis and sinusitis are also frequent. Anyone who has been diagnosed with HIV should receive the pneumococcal vaccine to decrease their risk of developing infection with Streptococcus pneumoniae, the most common cause of pneumonia. The vaccine should be repeated every five years. Some prophylactic medications for other opportunistic infections — such as trimethoprim-sulfamethoxazole for PCP and azithromycin and clarithromycin for Mycobacterium avium complex — also have the benefit of reducing the incidence of bacterial infections. If you regularly contract bacterial lung infections, your doctor may prescribe an antibiotic as a secondary preventive measure. However, the risk of breeding drug-resistant bacteria must be considered before taking any antibiotic on a regular basis.
- Kaposi's sarcoma. Kaposi's sarcoma is a malignancy that can develop among patients with HIV/AIDS. It typically causes purple blotches on the skin. Although the skin lesions are not life-threatening, Kaposi's sarcoma often progresses, spreading to the lungs or other internal organs. When the disease involves the lungs, it often causes a cough or shortness of breath. Although patients often improve with chemotherapy, Kaposi's sarcoma is an incurable tumor. The skin tumors are often treated with radiation therapy or liquid nitrogen. HAART improves the immune system in AIDS patients, therefore decreasing the risk of developing Kaposi's sarcoma.
- Fungal infections. Pneumocystis jiroveci (Pneumocystis carinii or PCP) has recently been re-categorized and renamed as a fungus. Any HIV-positive person who has a CD4 count of less than 200 cells per microliter or who has a history of thrush (oropharyngeal candidiasis, an HIV-related fungal infection) or PCP should take preventive medications for PCP until their immune system is boosted by taking highly active antiretroviral therapy. Trimethoprim-sulfamethoxazole is the most effective medication for this purpose; other medications such as dapsone, pentamidine and atovaquone can be used if a patient has serious adverse reactions to trimethoprim-sulfamethoxazole. Preventive measures can be stopped in patients whose CD4 count has raised to greater than 200 cells per microliter for three to six months.
Other causes of fungal pneumonia, such as Coccidioides immitis, Cryptococcus neoformans, Nocardia species, Histoplasma capsulatum and Aspergillosis species, are usually only of concern to people with CD4 counts of less than 100 cells per microliter. Treatment involves antifungal medications such as amphotericin, voriconazole, fluconazole and itraconazole. Coccidioides, Cryptococcus, and histoplasmosis all require lifetime chronic therapy to prevent recurrence.
Some opportunistic infections, such as M. avium complex, can become disseminated and cause symptoms in the lungs, even though the infection is spread throughout the body. Complications from non-Hodgkin's lymphoma, toxoplasmosis and cytomegalovirus can also result in respiratory symptoms, but often other signs are already apparent.
HIV-related lung diseases are diagnosed in a number of ways. Typically, your doctor will start by eliciting a careful medical history. You will be asked about your symptoms, the length of time that you've had HIV/AIDS, opportunistic infections that you have experienced, medications you have been taking and places that you have traveled. Your doctor will then perform a careful physical examination, focusing on your chest. It is likely that radiology and laboratory studies, such as a chest X-ray and blood work (including white blood cell counts and liver function) and possibly a test of arterial blood gases, will be ordered as well. Your doctor may also take a sample of sputum to test for pathogens such as tuberculosis and P. carinii. In certain cases, your doctor may order a bronchoscopy, which is an examination of the tubes leading to your lungs. If you have not recently had your CD4 count and viral load tested, your doctors will order these tests as well, to assess your risk of developing particular respiratory infections.
For most opportunistic infections affecting the lung, your doctor will treat you with antibiotic medications, such as trimethoprim-sulfamethoxazole, azithromycin or clarithromycin. For cancers such as non-Hodgkin's lymphoma or Kaposi's sarcoma, you may need chemotherapy.
HAART is the most effective way to prevent opportunistic infections, in that it typically boosts your immune system enough to prevent you from developing many infections. If your CD4 count is low, you may need to take medications to prevent the onset of certain illnesses. Secondary preventive measures — in order to prevent the recurrence of the illness — are sometimes needed lifelong. Be sure to tell your doctor what other medications you are taking; dangerous interactions can occur between HAART and drugs for opportunistic infections. Side effects to these preventive medications vary but may include anemia, diarrhea, liver and kidney damage, peripheral neuropathy, rashes and inflammation of the pancreas.
It is wise for anyone with HIV to follow commonsense advice, such as eating well, getting enough rest and avoiding cigarettes and illegal drug use. Your doctor may suggest you limit certain types of international travel because some types of bacterial, parasitic, fungal and viral infections occur more commonly in developing countries. In addition, tuberculosis is far more common in resource-poor regions of the world, and it thrives in health care centers, prisons and other close and cramped places.
You also must be certain to take all of your medications, especially your HAART therapy, to reduce the likelihood of developing drug-resistant disease.
Last updated March 23, 2007
