Noninfectious pulmonary complications of human immunodeficiency virus infection

Abstract

Human immunodeficiency virus type 1 (HIV-1) is the retrovirus responsible for the development of AIDS. Its profound impact on the immune system leaves the host vulnerable to a wide range of opportunistic infections not seen in individuals with a competent immune system. Pulmonary infections dominated the presentations in the early years of the epidemic, and infectious and noninfectious lung diseases remain the leading causes of morbidity and mortality in persons living with HIV despite the development of effective antiretroviral therapy. In addition to the long known immunosuppression and infection risks, it is becoming increasingly recognized that HIV promotes the risk of noninfectious pulmonary diseases through a number of different mechanisms, including direct tissue toxicity by HIV-related viral proteins and the secondary effects of coinfections. Diseases of the airways, lung parenchyma and the pulmonary vasculature, as well as pulmonary malignancies, are either more frequent in persons living with HIV or have atypical presentations. As the pulmonary infectious complications of HIV are generally well known and have been reviewed extensively, this review will focus on the breadth of noninfectious pulmonary diseases that occur in HIV-infected individuals as these may be more difficult to recognize by general medical physicians and subspecialists caring for this large and uniquely vulnerable population.

FIGURE 1

(A) Characteristic chest computerized tomographic findings of nonspecific interstitial pneumonitis are seen in this image, including ground glass opacities, bronchiectasis and fibrosis (arrow). Image provided by courtesy of Dr. Travis Henry. (B) Histopathological features of nonspecific interstitial pneumonitis are evident in this hematoxylin and eosin stain of an open lung biopsy section, including interstitial infiltration of lymphocytes, macrophages and plasma cells. Image provided by courtesy of Dr. Anthony Gal.

FIGURE 2

(A) Chest computerized tomographic findings in lymphocytic interstitial pneumonitis, also known as lymphocytic interstitial pneumonitis (LIP) are evident in this image, including so-called “tree-in-bud” opacities representing lymphocytic aggregation (arrow) and peribronchial cuffing. Image provided by courtesy of Dr. Travis Henry. (B) Histopathologically, LIP often appears as lymphocytic interstitial infiltration as seen in this hematoxylin and eosin–stained section from an open lung biopsy. Image provided by courtesy of Dr. Anthony Gal.

FIGURE 3

Hematoxylin and eosin–stained section from an open lung biopsy in a patient with HIV shows the classic pathologic feature of pulmonary arterial hypertension; namely, the plexiform lesions that occlude blood flow within remodeled pulmonary arteries (arrow points to a typical plexiform lesion). Image provided by courtesy of Dr. Anthony Gal.

FIGURE 4

(A) Chest computerized tomographic finding in a patient with pulmonary involvement by Kaposi's sarcoma demonstrates flame-shaped lesions tracking into the lung from the hila along the bronchovascular bundles (arrow) as well as nodular densities and ground glass opacities. Image provided by courtesy of Dr. Travis Henry. (B) Hematoxylin and eosin–stained section from an open lung biopsy in a patient with Kaposi's sarcoma shows the classic spindle cells and high vascularity that are diagnostic for this AIDS-related malignancy. Image provided by courtesy of Dr. Anthony Gal.