HIV/AIDS and Lung Disease Fact Sheet
The lung is a major target of attack in HIV-positive and AIDS patients because the human immunodeficiency virus inhibits the body's ability to defend itself against infections and some kinds of cancer. People with HIV or AIDS are at a greater risk for contracting "opportunistic" lung diseases because these diseases take advantage of the body's lowered defenses. Some of these are described below. In addition the virus itself may cause lung damage.
 Pneumocystis carinii pneumonia (PCP) is the first sign of illness in more than half of all persons with AIDS. It often can be successfully treated, usually with an antibiotic combination for two to three weeks or more. PCP is not contagious. Without preventive medicine over 80% of people with HIV will likely get PCP.
The most common form of prophylactic (preventive) measure and treatment is an antibiotic combination of trimethoprim and sulfamethoxazole (TMP-SMX). This drug combination is usually given orally. Another frequently used drug is pentamidine, which is given intravenously or, for prevention, often in the form of aerosol mist, in order to deliver the major portion directly to the lungs, avoiding adverse side effects on other organs. Delivery of the agent even more directly, using pulmonary surfactant as a vehicle, is now being explored.
Tuberculosis (TB) is caused by the bacillus Mycobacterium tuberculosis. Approximately 12 million people worldwide are coinfected with HIV and TB, and an individual who is infected with both HIV and TB has a 7 to 10 percent chance per year of developing active TB compared to a 12 percent lifetime chance in people without HIV.
Tuberculosis is contagious among people who are in contact with one another over a long period of time, since it is spread by airborne droplets--coughs, sneezes, and singing. Many
people--as many as 10 to 15 million--have latent TB infection; they are not sick but carry the bacterium. They are at risk for developing the disease, especially if they are coinfected with HIV or are weakened by some other illness.
The AIDS epidemic is a major contributing factor in the increased number of TB cases, since HIV's suppression of the immune system allows new active infection and permits activation of latent disease.
Mycobacterium avium complex (MAC) afflicts up to 20 to 30 percent of HIV-infected persons. The bacterium is widely distributed in the environment, but it rarely causes illness. There is no evidence of person-to-person transmission. In the presence of HIV it causes lung disease, anemia and swollen lymph nodes, and infects the blood and entire body.
Fungal infections that may attack the lungs-as weak as other organs-of AIDS patients include candidiasis. These fungi may cause illness in the non-AIDS population as well, but the infections are often more common, more severe, and more difficult to treat in AIDS patients. A number of antifungal drugs are in established use, and others are under investigation; among those currently employed are amphotericin B, miconazole, and flucytosine. Fungal infections of the lung are not transmissible to healthy people.
Viral pneumonia and
bacterial pneumonia are easily contracted by persons with AIDS and HIV. A prominent cause of viral pneumonia in persons with immune system deficiencies are members of the virus group herpesvirus, which have shown to be stubbornly resistant to treatment. Bacterial pneumonia is caused by various bacteria such as Haemophilus influenzae and Legionella pneumonia. Well-established antibiotic treatments are used for bacterial pneumonia.
There are other less common types of lung disease that also afflict persons with AIDS. Kaposi's sarcoma, a cancer which also affects other parts of the body, can cause damage to the lungs. Nonspecific interstitial pneumonitis and small airways disease are two other forms of lung disease that affect people with AIDS.
A person who has AIDS or is HIV-positive can take precautions to help prevent lung disease, although it is impossible to guarantee that these steps will enable the person to avoid these diseases. The patient should be inoculated against pneumococcal pneumonia and influenza, and receive PCP prophylaxis.
It is essential that persons with AIDS or HIV avoid anything that promotes lung damage, since it would further weaken the body's defenses against infection. "Recreational drugs" such as alcohol and cigarettes, as well as illegal drugs can and do cause lung damage.
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