Seminars in Roentgenology
Volume 42, Issue 1 , Pages 23-36 , January 2007

Thoracic Infections in Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome

  • Galit Aviram, MD

      Affiliations

    • Department of Radiology at Tel Aviv Sourasky Medical Center and Tel Aviv University, Tel-Aviv, Israel.
  • ,
  • Joel E. Fishman, MD, PhD

      Affiliations

    • Jackson Memorial Hospital and University of Miami School of Medicine, Miami, Florida.
  • ,
  • Phillip M. Boiselle, MD

      Affiliations

    • Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
    • Corresponding Author InformationAddress reprint requests to Phillip M. Boiselle, MD, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.

References 

  1. AIDS epidemic update. December 2005. UNAIDS and World Health Organization. (Available at: http//www.who.int/hiv/epi-update)
  2. Steinbrook R. The AIDS epidemic in 2004. N Engl J Med. 2004;351:115–117
  3. Diagnosis of HIV/AIDS—32 states, 2000-2003. MMWR Morb Mortal Weekly Rep. 2004;53:1106–1110
  4. Patella FJ, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency infection. N Engl J Med. 1998;338:853–860
  5. Khalsa AM. Preventive counseling, screening and therapy for the patients with newly diagnosed HIV infection. Am Fam Physician. 2006;73:271–280
  6. Center for Disease Control and Prevention. In: HIV/AIDS surveillance Report 2004. Vol. 16:Atlanta: US Department of Human Services, CDC; 2005;p. 1–46Also available at: http//www.cdc.gov/hiv/stata/harslink.htm
  7. Boiselle PM, Aviram G, Fishman JE. Update on lung disease in AIDS. Semin Roentgenol. 2002;37:54–71
  8. McGuiness G. Changing trends in the pulmonary manifestations of AIDS. Radiol Clin North Am. 1997;35:1029–1082
  9. The world health report 2005—HIV/AIDS Epidemiological surveillance report for the WHO African region 2005 update. Harare Zimbabwe: World Health Organization; 2005;December (Available at: http//www.who.int/hiv)
  10. Lawn DS, Bekker LG, Miller RF. Immune reconstitution disease associated with mycobacterial infections in HIV-infected individuals receiving antiretrovirals. Lancet Infect Dis. 2005;5:361–373
  11. Phillips P, Bonner S, Gataric T, et al. Nontuberculous mycobacterial immune reconstitution syndrome in HIV-infected patients: spectrum of disease and long-term follow up. Clin Infect Dis. 2005;41:1483–1497
  12. Fauci AS, Lane HC. Human immunodeficiency virus disease: AIDS and related disorders. In:  Kasper DL,  Fauci AS,  Dan LL, et al. editor. (ed 16).. Harrison’s Principles of Internal Medicine. vol. 1:McGraw-Hill: New York, NY; 2005;p. 1076–1139
  13. Centers for Disease Control and Prevention (CDC). Treating opportunistic infections among HIV-infected adults and adolescents. MMWR Morb Mortal Weekly Rep. 2004;53(RR-15):1–112
  14. Centers for Disease Control and Prevention (CDC). Guidelines for preventing opportunistic infections among HIV-infected persons. MMWR Morb Mortal Weekly Rep. 2002;51(RR-08):1–46
  15. Hoover DR, Saah AJ, Bacellar H, et al. Clinical manifestations of AIDS in the era of Pneumocystis prophylaxis. N Engl J Med. 1993;329:1922–1926
  16. Martin JN, Rose DA, Hadley WK, et al. Emergence of trimethoprim-sulfamethoxasole resistance in AIDS era. J Infect Dis. 1999;180:1809–1818
  17. Anglaret X, Messou E, Quassa T, et al. Pattern of bacterial diseases in a cohort of HIV-1 infected adults receiving cotrimoxazole prophylaxis in Abidjan, Cote d’lvoire. AIDS. 2003;17:575–584
  18. Hanson DL, Chu SY, Farizo KM, et al. Distribution of CD4+ lymphocytes at diagnosis of acquired immunodeficiency syndrome-defining and other human immunodeficiency virus-related illnesses. Arch Intern Med. 1995;155:1537–1542
  19. Agostini C, Trentin L, Zambello R, et al. HIV-1 and the lung: Infectivity, pathogenic mechanisms, and cellular immune responses taking place in the lower respiratory tract. Am Rev Respir Dis. 1993;147:1038–1049
  20. Maki DD. Pulmonary infections in HIV/AIDS. Semin Roentgenol. 2000;35:124–139
  21. Haramati LB, Jenny-Avital ER. Approach to the diagnosis of pulmonary disease in patients infected with the human immunodeficiency virus. J Thorac Imaging. 1998;13:247–260
  22. Centers for Disease Control. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Morb Mortal Weekly Rep. 1992;41:1–19
  23. Hirschtick RE, Glassroth J, Jordan MC, et al. Pulmonary complications of HIV infection study group Bacterial pneumonia in persons infected with the human immunodeficiency virus. N Engl J Med. 1995;333:845–851
  24. Aboulafia DM. The epidemiologic, pathologic, and clinical features of AIDS associated pulmonary Kaposi’s sarcoma. Chest. 2000;117:1128–1145
  25. Miquez-Burbano MJ, Ashkin D, Rodriguez A, et al. Increased risk of pneumocystis carinii and community acquired pneumonia with tobacco use in HIV disease. Int J Infect Dis. 2005;9:208–217
  26. Serraino D, Puro V, Boumis E, et al. Epidemiological aspects of major opportunistic infections of the respiratory tract in persons with AIDS: Europe 1993-2000. AIDS. 2003;17:2109–2116
  27. Castaner E, Gallardo X, Mata JM, et al. Radiologic approach to the diagnosis of infectious pulmonary disease in patients infected with human immunodeficiency virus. Eur J Radiol. 2004;51:114–129
  28. Boiselle PM, Tocino I, Hooley RJ, et al. Chest radiograph interpretation of Pneumocystis carinii pneumonia, bacterial pneumonia and pulmonary tuberculosis in HIV-positive patients: accuracy, distinguishing features, and mimics. J Thorac Imaging. 1997;12:47–53
  29. Gold JA, Rom WN, Harkin TJ. Significance of abnormal chest radiograph findings in patients with HIV-1 infection without respiratory symptoms. Chest. 2002;121:1472–1477
  30. Kang EY, Staples CA, McGuiness G, et al. Detection and differential diagnosis of pulmonary infections and tumors in patients with AIDS: value of chest radiography versus CT. AJR Am J Roentgenol. 1996;166:15–19
  31. Padley SPG, King LJ. Computed tomography of the thorax in HIV disease. Eur Radiol. 1999;9:1556–1569
  32. Marchiori E, Muller NL, Souza AS, et al. Pulmonary disease in patients with AIDS: high resolution CT and pathologic findings. AJR Am J Roentgenol. 2005;184:757–764
  33. Hartman TE, Primack SL, Müller NL, et al. Diagnosis of thoracic complications in AIDS: accuracy of CT. AJR Am J Roentgenol. 1994;162:547–553
  34. Schuster DM, Alazraki N. Gallium and other agents in disease of the lung. Semin Nucl Med. 2002;32:193–211
  35. O’Doherty MJ, Barrington SF, Campbell M, et al. PET scanning and the human immunodeficiency virus-positive patient. J Nucl Med. 1997;38:1575–1583
  36. Love C, Tomas MB, Tronco GG, et al. FDG PET for infection and inflammation. Radiographics. 2005;25:1357–1368
  37. Noskin GA, Glassroth J. Bacterial pneumonia associated with HIV-1 infection. Clin Chest Med. 1996;17:713–723
  38. Schneider RF. Bacterial pneumonia. Semin Respir Infect. 1999;14:327–332
  39. Mayuad C, Parrot A, Cadranel J. Pyogenic bacterial lower respiratory tract infection in human immunodeficiency virus-infected patients. Eur Respir J. 2002;20(suppl):28–39
  40. Aviram G, Boiselle PM. Imaging features of bacterial respiratory infections in AIDS. Curr Opin Pulm Med. 2004;10:183–188
  41. Feikin D, Feldman C, Schuchat A, et al. Global strategies to prevent bacterial pneumonia in adults with HIV disease. Lancet Infect Dis. 2004;4:445–455
  42. Afessa B, Green W, Chiao J, et al. Pulmonary complications of HIV infection (Autopsy findings). Chest. 1998;113:1225–1229
  43. Petrosillo N, Nicastri E, Viale P. Nosocomial pulmonary infections in HIV-positive patients. Curr Opin Pulm Med. 2005;11:231–235
  44. Sorvillo F, Beall G, Turner PA, et al. Incidence and determinants of Pseudomonas aeruginosa infection among persons with HIV: association with hospital exposure. Am J Infect Control. 2001;29:79–81
  45. Afessa B, Green B. Bacterial pneumonia in hospitalized patients with HIV infection: the pulmonary complications, ICU support, and prognostic factors of hospitals patients with HIV (PIP) study. Chest. 2000;117:1017–1022
  46. Rimland D, Navin TR, Lennox JA, et al. Prospective study of etiologic agents of community-acquired pneumonia in patients with HIV infection. AIDS. 2002;16:85–95
  47. Bartlett JG. Pneumonia in the patient with HIV infection. Infect Dis Clin North Am. 1998;12:807–820
  48. Selwyn PA, Pumerantz AD, Durante A, et al. Clinical predictors of Pneumocystis carinii pneumonia, bacterial pneumonia and tuberculosis in HIV-infected patients. AIDS. 1998;12:885–893
  49. French N, Williams G, Williamson V, et al. The radiographic appearance of pneumococcal pneumonia in adults is unaltered by HIV-1-infection in hospitalized Kenyans. AIDS. 2002;16:2095–2096
  50. Brecher CW, Aviram G, Boiselle PM. CT and radiography of bacterial infections in AIDS patients. AJR Am J Roentgenol. 2003;180:1203–1209
  51. Jasmer RM, Edinburgh KJ, Thompson A, et al. Clinical and radiographics predictors of pulmonary nodules in HIV-infected patients. Chest. 2000;117:1023–1030
  52. Franquet T, Muller NL, Gimenez A, et al. Infectious pulmonary nodules in immunocompromised patients (Usefulness of computed tomography in predicting their etiology). J Comput Assist Tomogr. 2003;27:461–468
  53. Aviram G, Fishman JE, Sagar M. Cavitary lung disease in AIDS: etiologies and correlation with immune status. AIDS Patient Care STDS. 2001;15:353–361
  54. Sider L, Gabriel H, Curry DR, et al. Pattern recognition of the pulmonary manifestations of AIDS on CT scans. Radiographics. 1993;13:771–784
  55. Borge JH, Michavila IA, Mendez JM, et al. Thoracic empyema in HIV-infected patients (Microbiology, management and outcome). Chest. 1998;113:732–738
  56. Fishman JE, Sagar M. Thoracic lymphadenopathy in HIV patients: spectrum of disease and differential diagnosis. AIDS Patient Care STDS. 1999;13:645–649
  57. Moore EH, Russel LA, Klein JS, et al. Bacillary angiomatosis in patients with AIDS: multiorgan imaging findings. Radiology. 1995;197:67–72
  58. Pintado V, Gomez-Mampaso E, Cobo J, et al. Nocardial infection in patients infected with human immunodeficiency virus. Clin Microbiol Infect. 2003;9:716–720
  59. Coche E, Beigelman C, Lucidarme O, et al. Thoracic bacillary angiomatosis in patient with AIDS. AJR Am J Roentgenol. 1995;165:56–58
  60. McGuinness G, Gruden JF, Bhalla M, et al. AIDS-related airway disease. AJR Am J Roentgenol. 1997;168:67–77
  61. Verghese A, Al-Samman M, Nabhan D, et al. Bacterial bronchitis and bronchiectasis in human immunodeficiency virus infection. Arch Intern Med. 1994;154:2086–2091
  62. Bartlett JG. Pneumonia in the patient with HIV infection. Infect Dis Clin North Am. 1998;12:807–820
  63. Gelman M, King MA, Neal DE, et al. Focal air trapping in patients with HIV infection: CT evaluation and correlation with pulmonary function test results. AJR Am J Roentgenol. 1993;172:1033–1038
  64. McGuinness G, Naidich DP, Garay S, et al. AIDS associated bronchiectasis: CT features. J Comput Assist Tomogr. 1993;17:260–266
  65. King MA, Neal DE, St. John R, et al. Bronchial dilatation in patients with HIV infection: CT assessment and correlation with pulmonary function tests results and findings at bronchoalveolar lavage. AJR Am J Roentgenol. 1997;168:1535–1540
  66. Boiselle PM, Crans CA, Kaplan MA. The changing face of Pneumocystis carinii pneumonia in AIDS patients. AJR Am J Roentgenol. 1999;172:1301–1309
  67. Boyton RJ. Infectious lung complications in patients with HIV/AIDS. Curr Opin Pul Med. 2005;11:203–207
  68. Morris A, Lundgren JD, Masur H, et al. Current epidemiology of Pneumocystis pneumonia. Emerg Infect Dis. 2004;10:1713–1720
  69. Kuhlman JE. Pneumocystis infections: the radiologist’s perspective. Radiology. 1996;198:623–635
  70. Crans CA, Boiselle PM. Imaging features of Pneumocystis carinii pneumonia. Crit Rev Diagn Imaging. 1999;40:251–284
  71. DeLorenzo LJ, Huang CT, Maguire GP, et al. Roentgenographic patterns of Pneumocystis carinii pneumonia in 104 patients with AIDS. Chest. 1987;91:323–327
  72. Franquet T, Gimenez A, Hidalgo A. Imaging of opportunistic fungal infections in immunocompromised patient. Eur J Radiol. 2004;51:130–138
  73. Datta D, Abbas AS, Henken EM, et al. Pneumocystis carinii pneumonia: the time course of clinical and radiographic improvement. Chest. 2003;124:1820–1823
  74. Gruden JF, Huang L, Turner J, et al. High-resolution CT in the evaluation of clinically suspected Pneumocystis carinii pneumonia in AIDS patients with normal, equivocal, or nonspecific radiographic findings. AJR Am J Roentgenol. 1997;169:967–975
  75. Opravil M, Marincek B, Fuchs W, et al. Shortcomings of chest radiography in detecting Pneumocystis carinii pneumonia. J Acquir Immune Defic Syndr. 1994;7:39–45
  76. Sandhu JS, Goodman PC. Pulmonary cysts associated with Pneumocystis carinii pneumonia in patients with AIDS. Radiology. 1989;173:33–35
  77. Chow C, Templeton PA, White CS. Lung cysts associated with Pneumocystis carinii pneumonia: radiographic characteristics, natural history, and complications. AJR Am J Roentgenol. 1993;161:527–531
  78. Wassermann K, Pothoff G, Kirn E, et al. Chronic Pneumocystis carinii pneumonia in AIDS. Chest. 1993;104:667–672
  79. Markowitz N, Hansen NI, Hopewell PC, et al. The pulmonary complications of HIV infection study group Incidence of tuberculosis in the United States among HIV-infected persons. Ann Intern Med. 1997;126:123–132
  80. Hung C, Chang S. Impact of highly active retroviral therapy on incidence and management of human immunodeficiency virus-related opportunistic infections. J Antimicrob Chemother. 2004;54:849–853
  81. Havlir DV, Barnes PF. Tuberculosis in patients with human immunodeficiency virus infection. New Engl J Med. 1999;340:367–373
  82. Geng E, Kreiswirth B, Burzynski J, et al. Clinical and radiographic correlates of primary and reactivation tuberculosis (A molecular epidemiology study). JAMA. 2005;293:2740–2745
  83. Leung AN. Pulmonary tuberculosis: the essentials. Radiology. 1999;210:307–322
  84. Saurborn D, Fishman JE, Boiselle PM. The imaging spectrum of pulmonary tuberculosis in AIDS. J Thorac Imaging. 2002;17:28–33
  85. Washington L, Miller WT. Mycobacterial infection in immunocompromised patients. J Thorac Imag. 1998;13:271–281
  86. Greenberg SD, Frager D, Suster B, et al. Active pulmonary tuberculosis in patients with AIDS: spectrum of radiographic findings (including a normal appearance). Radiology. 1994;193:115–119
  87. Aderaye G, Bruchfeld J, Afessa G, et al. The relationship between disease pattern and disease burden by chest radiography (M. Tuberculosis load, and HIV status in patients with pulmonary tuberculosis in Addis Ababa). Infection. 2004;32:333–338
  88. French MAH. Antiretroviral therapy (Immune restoration disease in HIV-infected patients on HAART). AIDS Read. 1999;9:548–562
  89. Jetovic DJ, Salemovic D, Ranin J, et al. The prevalence and risk of immune restoration disease in HIV-infected patients treated with highly active antiretroviral therapy. HIV Med. 2005;6:140–143
  90. French MA, Price P, Stone SF. Immune restoration disease after antiretroviral therapy. AIDS. 2004;18:1615–1627
  91. Lawn SD, Bekker LG, Miller RF. Immune reconstitution disease associated with mycobacterial infections in HIV-infected individuals receiving antiretrovirals. Lancet Infect Dis. 2005;5:361–375
  92. Fishman JE, Saraf-Lavi E, Narita M, et al. Pulmonary tuberculosis in AIDS patients: transient chest radiographic worsening after initiation of antiretroviral therapy. AJR Am J Roentgenol. 2000;174:43–49
  93. Buckingham SJ, Haddow LJ, Shaw PJ, et al. Immune reconstitution inflammatory syndrome in HIV-infected patients with mycobacterial infections starting highly active anti-retroviral therapy. Clin Radiol. 2004;59:505–513
  94. Fishman JE, Schwartz DS, Sais GJ. Mycobacterium kansasii pulmonary infection in patients with AIDS: spectrum of chest radiographic findings. Radiology. 1997;204:171–175
  95. Miquez-Burbano MJ, Flores M, Ashkin D, et al. Non-tuberculous mycobacteria disease as a cause of hospitalization in HIV-infected subjects. Int J Infect Dis. 2006;1:47–55
  96. Modilevsky T, Sattler FR, Barnes PF. Mycobacterial disease in patients with human immunodeficiency virus. Arch Intern Med. 1989;149:2201–2205
  97. Phillips P, Bonner S, Gataric N, et al. Nontuberculous mycobacterial immune reconstitution syndrome in HIV-infected patients: spectrum of disease and long term follow up. Clin Infect Dis. 2005;41:1483–1597
  98. Rizzi EB, Schinina V, Bellussi A, et al. Pulmonary mycosis in AIDS. Eur J Radiol. 2001;37:42–46
  99. Mylonakis E, Barlam TF, Flanigan T, et al. Pulmonary aspergillosis and invasive disease in AIDS: review of 342 cases. Chest. 1998;114:251–262
  100. Wallace JM, Lim R, Browdy BL, et al. Pulmonary complications of HIV study group Risk factors and outcomes associated with identification of Aspergillus in respiratory specimens from persons with HIV disease. Chest. 1998;114:131–137
  101. Staples CA, Kang EY, Wright J, et al. Invasive pulmonary aspergillosis in AIDS: radiographic, CT and pathologic findings. Radiology. 1995;196:409–414
  102. Wallace JM, Hannah J. Cytomegalovirus pneumonitis in patients with AIDS: Findings in an autopsy study. Chest. 1987;92:198–203
  103. McGuiness G, Scholes JV, Garay SM, et al. Cytomegalovirus pneumonitis: spectrum of parenchymal CT findings with pathologic correlation in 21 AIDS patients. Radiology. 1994;192:451–459
  104. Uberti-Foppa C, Lillo F, Terreni MR, et al. Cytomegalovirus pneumonia in AIDS patients: value of cytomegalovirus culture from BAL fluid and correlation with lung disease. Chest. 1998;113:919–923
  105. Waxman AB, Goldie SJ, Brett-Smith H, et al. Cytomegalovirus as a primary pulmonary pathogen in AIDS. Chest. 1997;111:128–134

PII: S0037-198X(06)00058-7

doi: 10.1053/j.ro.2006.08.004

Seminars in Roentgenology
Volume 42, Issue 1 , Pages 23-36 , January 2007