APPROACH TO THE DIAGNOSIS OF PULMONARY-DISEASE IN PATIENTS INFECTED WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS

Patients infected with the human immunodeficiency virus are predispose d to develop a variety of common and uncommon infectious and neoplasti c pulmonary diseases. Clinical information that can stratify the risk of occurrence of these pulmonary conditions includes: 1) CD4 cell coun t--the most important determinant; 2) concurrent antimicrobial therapy ; 3) prior travel history 4) known latent infections that may reactiva te; and 5) underlying respiratory disease. Specific pulmonary diseases are discussed including: bacterial pneumonia, bronchitis, mycobacteri al and fungal infections, pneumocystis carinii pneumonia, toxoplasmosi s, cytomegalovirus, Kaposi sar coma, lymphoma, and lung cancer. A diff erential diagnosis can be generated based on the chest radiographic pa ttern. Focal or multifocal areas of consolidation usually represent co nventional bacterial pneumonia or, less commonly, tuberculosis. In sev erely immunocompromised patients, unusual diseases causing consolidati on should be considered including: Rhodococcus infection, nocardiosis, cryptococcosis, aspergillosis, and lymphoma. Nodules can be present i n tuberculosis, histoplasmosis, cryptococcosis, and Kaposi sarcoma. In terstitial opacities are common in pneumocystis carinii pneumonia, his toplasmosis, and cytomegalovirus pneumonia. Cavitation and cysts are f eatures of pneumocystis carinii pneumonia, tuberculosis, aspergillosis , and lung cancer. Disease of the airways is increasingly recognized i n those with acquired immunodeficiency syndrome. Lymphadenopathy is mo st common in mycobacterial infection, but can be a feature of fungal i nfection, lymphoma, Kaposi sarcoma, and lung cancer. The combined use of clinical information, knowledge of typical conditions associated wi th the human immunodeficiency syndrome, and radiographic patterns offe rs a useful approach to the diagnosis of pulmonary disease in the pati ent with the human immunodeficiency virus.