Almost any kind of infection is a possible lung disease risk in the presence of HIV. In addition, several types of lung disease are included in the list of AIDS indicator diseases. This means that an individual who is HIV positive and who has one of those diseases is considered to have AIDS.
The forms of lung disease that are included in the list of AIDS indicators are Pneumocystis carinii pneumonia, cytomegalovirus, mycobacterium avium complex, mycobacterium kansasii, pulmonary tuberculosis, and recurrent bacterial pneumonia. In addition, it appears that the AIDS virus itself can cause a form of chronic lung disease.
The major AIDS-related infections that are potentially preventable and/or treatable:
Pneumocystis Carinii Pneumonia (PCP)
Pneumocystis carinii pneumonia (PCP) is caused by an unusual fungus. PCP is the first sign of illness in more than half of all persons with AIDS, and perhaps 80 percent (four out of five) will develop it sooner or later without proper preventive treatment. However, it can be successfully treated in many cases. While it may recur a few months later, treatment can help to prevent or delay its recurrence.
Initial treatment for PCP is often an antibiotic combination, trimethoprim and sulfamethoxazole (TMP-SMZ), usually given intravenously (IV) for two to three weeks. Another drug used to treat PCP is called pentamidine.
TMP-SMZ is also used for prophylactic (preventive) treatment, and pentamidine given by an aerosol spray appears useful for that purpose, too.
Additional drugs are being explored, with the goal of finding treatments that are at least as effective as those now in use, and that have minimal side effects.
PCP is not thought to be contagious.
Tuberculosis (TB) is caused by the bacillus Mycobacterium tuberculosis. Many Americans, perhaps, according to recent estimates, as many as 10 million, have latent TB infection: they are not sick, but they are carrying the bacterium (as shown by a positive reaction to the TB skin test). They may have acquired the TB infection much earlier in life.
Such waiting-to-attack infection can become definite illness when a person’s defenses are weakened by HIV.
Health authorities recommend an annual TB skin test called a tuberculin test for all persons who are HIV positive. If the test is positive, a chest X-ray and complete physical exam are in order. But a negative test does not rule out TB disease in an HIV patient.
Also, additional tests, which can include another tuberculin skin test, a chest X-ray, and a complete physical exam, may be requested of people with a negative skin test reaction who are HIV infected. Damage to the immune system, such as that caused by AIDS, can result in a falsely negative TB skin test result even when TB infection is present.
Preventive treatment with isoniazid is essential for someone who has tested positive for both HIV and the TB bacteria. Health authorities recommend at least twelve months of preventive therapy for HIV infected individuals.
In persons with HIV infection, tuberculosis sometimes affects other parts of the body, not just the lungs; these may include bones, joints, the gastrointestinal tract, and other areas. People who are HIV positive should therefore be alert for unusual symptoms anywhere.
TB is treated with a combination of antibacterial drugs on a schedule that may continue for nine months or longer; among the most widely used drugs are isoniazid, rifampin, and pyrazinamide. TB is contagious while the disease is untreated, but the typical patient becomes noninfectious very rapidly after beginning treatment, within several days to a few weeks.
Recently there has been an increase in the number of cases of TB that are resistant to one or more drugs. Multidrug-Resistant TB (MDR-TB) first develops when a patient with TB does not complete his or her full drug therapy.
If a patient who is being treated for TB stops taking their medicine or is inadequately treated, and gets sick again with TB, the TB bacteria may not be affected by the drugs previously used to treat the illness. The bacteria have become “resistant to” those drugs.
MDR-TB can also be transmitted to other individuals in the same way that tuberculosis is transmitted. MDR-TB cases are especially hard to treat because the physician has a limited range of drugs that can be used. MDR-TB is especially dangerous for individuals who are HIV infected.
Mycobacterium Avium Complex
Mycobacterium avium complex is caused by an organism closely related to the bacillus that causes tuberculosis. It is widely distributed in the environment and very rarely causes illness; in combination with HIV, it may cause lung disease along with inflamed lymph nodes (“swollen glands”) and infection in other parts of the body.
There is no evidence of person-to-person transmission of Mycobacterium avium complex.
Fungal infections may affect various parts of the body, including the lungs; they include histoplasmosis, aspergillosis, cryptococcosis, candidiasis, and others. The fungi that cause these diseases are generally widespread, but some are found only in particular geographic areas.
There are a number of antifungal drugs, both established and experimental, that may be effective against one or more of these disease-causing organisms. They include amphotericin, ketoconazole, flucytosine, fluconazole, and others.
Most fungal infections of the lungs cannot be transmitted from one person to another.
Viral pneumonias, like most viral infections, are not easy to treat under any circumstances. The most prominent causes of viral pneumonia in persons with immune-system deficiencies are members of the virus group called herpes virus, especially herpes simplex and Cytomegalovirus (CMV).
Herpes simplex infection is treatable with antiviral drugs. CMV pneumonia has thus far proved stubbornly resistant to treatment.
These viruses, although contagious, are frequently carried by individuals without any illness.
Bacterial pneumonias do occur in the general population, whether or not people are infected with HIV, but HIV definitely raises the risk of contracting them. The chief causes are the bacteria Hemophilus influenzae, which has no connection with the better known “flu” (the viral illness influenza); the pneumococcus Streptococcus pneumoniae; and a few other bacteria, including Legionella pneumophila (which causes the pneumonia known as Legionnaires disease).
There are well-established antibiotic treatments for bacterial pneumonias.
Other Forms Of Lung Disease
Other forms of lung disease affecting people with AIDS do not easily fall in any of the above categories. Some, like Kaposi’s Sarcoma (KS), are primarily diseases found in other parts of the body but which have manifestations in the lungs.
KS is a cancer complicating HIV infection and although it can involve a variety of areas of the body, approximately a third of KS cases involve the lungs. So far there has been little success in treating KS.
Lymphoma is another type of cancer which is manifest in the lungs and especially in the lymph nodes near the lungs.
Nonspecific interstitial pneumonitis, which causes inflammation of the lungs and an increase in difficulty in breathing is another lung disease affecting some people with AIDS. The inflammation caused by interstitial pneumonitis is not as severe as that seen in PCP and generally stabilizes without treatment.
HOW CAN THESE INFECTIONS BE PREVENTED?
It would be misleading to say that there are ways a person who is HIV positive can be sure of avoiding these diseases; no such promise can be made. But if you are HIV positive, there are steps you can take that may help.
Some are sensible precautions everyone interested in preserving and improving health should take; others are more special. Among them:
Eat a well-balanced diet: good nutrition plays an important part in resisting disease.
Exercise in moderation, to the extent that you can.
Be vaccinated against pneumococcal pneumonia, as well as against viral influenza, which can sometimes lead to pneumonia. (Public-health authorities recommend that children with AIDS or positive HIV tests should receive all the standard childhood vaccines, except that they should be given injected polio vaccine instead of the oral type.)
Faithfully follow any medical advice you have received, whether for treatment or for disease prevention. If you have questions about medications or other matters, ask your doctor.
Avoid anything that may damage your lungs or your health generally and thus weaken your body’s defenses against infection. Most substances known as “recreational drugs,” including alcohol and cigarettes as well as illegal drugs, can and do cause some damage.
Let your doctor know if you have been tested and are HIV positive.
If you are HIV positive, get a TB skin test. Your doctor may suggest periodic chest x-rays. Follow your doctor’s advice about preventive therapy for TB.
Watch for the symptoms:
• Sweating, especially at night
• Coughing up blood
• Shortness of breath
• Difficulty in breathing
If they arise, or if in doubt, see a physician without delay! Treatments and medications mentioned here are intended as examples only. Your care must be individualized by your physician.