Etiology of Respiratory Complications among Iranian HIV Infected Patients

Abstract

Background: Infection with Human Immune deficiency Virus (HIV) is a growing problem in developing countries. Among HIV infected cases, respiratory complications are common, dissimilar in different setting and their diagnosis is challenging. The aim of this study was to determine the spectrum of infectious and non-infectious pulmonary complications among HIV infected patients.

Materials and methods: The retrospective study was done among 710 HIV infected patients admitted in Masih Daneshvari Hospital, National Research Institute of Tuberculosis and Lung Diseases, Tehran, Iran from January 2003 to March 2017. Demographic, clinical, radiologic and laboratory data of 836 episodes of pulmonary complications were reviewed and final diagnosis were extracted.

Results: Mean of CD₄ cell count was 90±131 ×10⁶ cells/L. Definite etiology was found for 653 episodes (78.1%) of pulmonary complications. Infectious respiratory diseases were clearly more common than non-infectious etiologies, 86.1 and 7.6%, respectively. Pulmonary tuberculosis, as the leading cause, involved 542 cases (64.8%) and Pneumocystis jiroveci (P. jiroveci) was the second infectious agent that was found in 111 cases (13.2%). Among non- infectious causes, bronchiectasis and Chronic Obstructive Pulmonary Disease (COPD) exacerbation were on the top of the list, 21 of 64 (32.8%) and 18 0f 64 (28.1%), respectively. Many patients had more than one etiology. P. jiroveci had the highest tendency for dual infections (43 episodes).

Conclusion: Pulmonary complications, especially infections are common among HIV cases in Iran, among them tuberculosis is the most common. Respiratory problems may be the first presentation of HIV infection. Clinicians should be aware about the risk of dual infections. Screening for HIV among all tuberculosis cases and vice versa is recommend.

Keywords: AIDS; HIV; Pulmonary; Respiratory complications; Tuberculosis.

Figure 1.

Relationship between CD4 lymphocyte cell count and selected pulmonary complications. The bottom and top of the boxes show the first and third quartiles, and the band inside any box is the median. Ends of the whiskers represent the minimum and maximum of the CD4 for every disease.