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participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



NEWS AND NEW DEVELOPMENTS



Pulmonary Complications of HIV Infection [Beck JM et al. Am J Respir Crit Care Med 2001;164:2120] The authors provide a summary of the "Fourth Workshop on the Pulmonary Complications of HIV Infection," which was sponsored by the Division of Lung Diseases of the National Heart, Lung and Blood Institute, NIH. Highlights of this review for clinicians include the following:

P. carinii pneumonia
Diagnosis: Some clinicians treat empirically and reserve invasive procedures only for those who do not respond; the relative merits of this approach vs. pre-treatment diagnostic testing with bronchoscopy or induced sputum are not known [Chest 1999;115:1563].

  • PCR is very sensitive and may identify the organism in oropharyngeal washings to avoid invasive procedures, but this work also suggests a carrier state that may give false positives [J Clin Microbiol 1998;36:2068].
  • The DHPS mutation is associated with the use and duration of sulfa-trimethoprim prophylaxis, but this may only reflect exposure to the drug and does not necessarily indicate resistance. These mutations are associated with decreased host survival [Lancet 1999;354:1347].

Active TB appears to accelerate the course of HIV [JAIDS 1998;19:361]

  • A study of over 5,000 HIV-infected patients in Europe showed that active TB increased the mortality by about one-third, but it is not known if the increased mortality is attributable to TB itself [BMJ 1995;311:1468].

Bacterial pneumonia

  • PCP prophylaxis with TMP-SMX decreases the risk of bacterial pneumonia.
  • Pneumococcal vaccine does not appear to reduce the risk of bacterial pneumonia.

Emphysema

  • There appears to be a synergy between HIV infection and smoking resulting in an "emphysema-like condition" with the implication of cytotoxic lymphocytes in the pathogenesis of emphysema [Ann Intern Med 2000;132:369].

Neoplasms

  • Kaposi’s sarcoma is usually diagnosed by detecting typical lesions with bronchoscopy, but PCR to detect HHV8 DNA in BAL specimens appears to be sensitive and specific [Am J Respir Crit Care Med 1998;157:458].
  • A newly recognized disorder is primary effusional lymphoma that may be associated with HHV8 or EBV [Pathol Oncol Res 1999;5:87].

Comment: Perhaps the most remarkable feature of this fourth review by the NHLBI is the paucity of new information.
posted 1/18/2002





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