HIV-related Pneumonias

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Pneumonia that occurs in individuals that are infected with the human immunodeficiency virus (HIV). 

• Pneumocystis pneumonia: caused by a fungus called Pneumocystis jirovecii.

• Bacterial pneumonia: caused by Streptococcus pneumoniae and Haemophilus influenzae.

• Tuberculosis (TB): caused by the bacteria Mycobacterium tuberculosis.

• Viral pneumonias: caused by respiratory syncytial virus (RSV), influenza, and cytomegalovirus (CMV).

• Other fungal pneumonias: such as Cryptococcus neoformans and Histoplasma capsulatum.

1. Pneumocystis pneumonia: caused by Pneumocystis jirovecii > opportunistic as there are low levels of CD4+ T cells > proliferation in lungs, causing damage to alveoli and impairs the lung’s gas exchange ability.

2. Bacterial pneumonia: caused by Streptococcus pneumoniae and Haemophilus influenzae. Low immune system > bacterial colonise the lungs.

3. Tuberculosis (TB): same as bacteria pneumonia.

4. Viral pneumonias: caused by respiratory syncytial virus (RSV), influenza, and cytomegalovirus (CMV). These viruses cause inflammation + damage to respiratory epithelium.

• HIV infection.

• Low CD4+ T cell count.

• Non adherence to treatment.

• Exposure to pathogens.

• IV drug use e.g. sharing needles.

• Smoking.

• Poor socio economic conditions.

• Fever,

• Cough, persistent cough + productive.

• Shortness of breath, chest pain, rapid breathing (tachypnea).

• Fatigue, night sweats, weight loss.

• CT scan.

• Chest X-ray.

• CT Scan.

• Sputum culture.

• Medication treatment: antibiotics, antifungals, or antiviral drugs depending on cause.

• Antiretroviral therapy (ART): main treatment to control HIV replication, improve immune function, and reduce the risk of opportunistic infections, including pneumonias. This is generally started by a specialist.