Noninfectious Pulmonary Complications of HIV/AIDS
Noninfectious Pulmonary Complications of HIV/AIDS
Purpose of Review: This article reviews recent findings on noninfectious pulmonary complications of HIV/AIDS, with a focus on HIV/AIDS-related lung malignancies and pulmonary hypertension, and discusses their incidence in the highly active antiretroviral therapy (HAART) era.
Recent Findings: Noninfectious pulmonary complications of HIV/AIDS are now recognized as important contributors to morbidity and mortality in HIV-infected patients. This is especially the case for HIV-related lung cancer and other non-AIDS-defining malignancies, which are now being diagnosed with increased frequency in HIV-infected patients. The incidence of Kaposi sarcoma and AIDS-related lymphoma has decreased in the HAART era, but compared with the general population, the risk of these malignancies and pulmonary hypertension is still very high in HIV-infected patients. Concurrent use of HAART and chemotherapy improves prognosis and survival of patients with AIDS-related lymphoma. For patients with HIV-related pulmonary hypertension, some studies show no beneficial effect of HAART whereas other reports show that HAART improves patient survival and response to antihypertensive treatment.
Summary: The beneficial effect of HAART and improved immune response on the treatment of Kaposi sarcoma and AIDS-related lymphoma suggests that HIV or viral-induced immunosuppression plays an important role in the development of these malignancies. Evidence from current studies suggests that HAART does not protect against HIV-related lung cancer. The full impact of HAART on HIV pulmonary hypertension remains to be determined.
Pulmonary complications of AIDS represent major causes of morbidity and mortality in HIV-infected patients, and despite the advent of highly active antiretroviral therapy (HAART), the lung continues to be the most frequently involved organ in AIDS autopsy cases. Noninfectious pulmonary complications are common in HIV infection, including malignancies, pulmonary hypertension, and lymphoproliferative disorders. Kaposi sarcoma, non-Hodgkin lymphoma (NHL), and cervical cancer are considered AIDS-defining illness but several studies show that other cancers such as Hodgkin lymphoma, lung, lip, brain, testicular, colorectal, and liver cancers also occur in excess in HIV-infected patients. Chronic pulmonary complications like pulmonary hypertension, lymphocytic interstitial pneumonitis, nonspecific interstitial pneumonitis, and lymphocytic alveolitis also occur with increased frequency in HIV infection.
The use of HAART is associated with decrease in the incidence and mortality due to HIV-related infectious pulmonary complications and some AIDS-defining tumors such as Kaposi sarcoma. This does not appear to be the case, however, for several noninfectious complications of AIDS, such as HIV-related lung cancer, for which studies show increased incidence in the HAART era. This article reviews new findings regarding the occurrence of noninfectious pulmonary complications of HIV/AIDS in the HAART era, with a focus on AIDS-related lung malignancies and pulmonary hypertension. We will provide evidence-based analysis of studies published since 2003, the year of our previous review.
Purpose of Review: This article reviews recent findings on noninfectious pulmonary complications of HIV/AIDS, with a focus on HIV/AIDS-related lung malignancies and pulmonary hypertension, and discusses their incidence in the highly active antiretroviral therapy (HAART) era.
Recent Findings: Noninfectious pulmonary complications of HIV/AIDS are now recognized as important contributors to morbidity and mortality in HIV-infected patients. This is especially the case for HIV-related lung cancer and other non-AIDS-defining malignancies, which are now being diagnosed with increased frequency in HIV-infected patients. The incidence of Kaposi sarcoma and AIDS-related lymphoma has decreased in the HAART era, but compared with the general population, the risk of these malignancies and pulmonary hypertension is still very high in HIV-infected patients. Concurrent use of HAART and chemotherapy improves prognosis and survival of patients with AIDS-related lymphoma. For patients with HIV-related pulmonary hypertension, some studies show no beneficial effect of HAART whereas other reports show that HAART improves patient survival and response to antihypertensive treatment.
Summary: The beneficial effect of HAART and improved immune response on the treatment of Kaposi sarcoma and AIDS-related lymphoma suggests that HIV or viral-induced immunosuppression plays an important role in the development of these malignancies. Evidence from current studies suggests that HAART does not protect against HIV-related lung cancer. The full impact of HAART on HIV pulmonary hypertension remains to be determined.
Pulmonary complications of AIDS represent major causes of morbidity and mortality in HIV-infected patients, and despite the advent of highly active antiretroviral therapy (HAART), the lung continues to be the most frequently involved organ in AIDS autopsy cases. Noninfectious pulmonary complications are common in HIV infection, including malignancies, pulmonary hypertension, and lymphoproliferative disorders. Kaposi sarcoma, non-Hodgkin lymphoma (NHL), and cervical cancer are considered AIDS-defining illness but several studies show that other cancers such as Hodgkin lymphoma, lung, lip, brain, testicular, colorectal, and liver cancers also occur in excess in HIV-infected patients. Chronic pulmonary complications like pulmonary hypertension, lymphocytic interstitial pneumonitis, nonspecific interstitial pneumonitis, and lymphocytic alveolitis also occur with increased frequency in HIV infection.
The use of HAART is associated with decrease in the incidence and mortality due to HIV-related infectious pulmonary complications and some AIDS-defining tumors such as Kaposi sarcoma. This does not appear to be the case, however, for several noninfectious complications of AIDS, such as HIV-related lung cancer, for which studies show increased incidence in the HAART era. This article reviews new findings regarding the occurrence of noninfectious pulmonary complications of HIV/AIDS in the HAART era, with a focus on AIDS-related lung malignancies and pulmonary hypertension. We will provide evidence-based analysis of studies published since 2003, the year of our previous review.