Non-infective pulmonary disease in HIV-positive children

Abstract

It is estimated that over 90% of children infected with human immunodeficiency virus (HIV) live in the developing world and particularly in sub-Saharan Africa. Pulmonary disease is the most common clinical feature of acquired immunodeficiency syndrome (AIDS) in infants and children causing the most morbidity and mortality, and is the primary cause of death in 50% of cases. Children with lung disease are surviving progressively longer because of earlier diagnosis and antiretroviral treatment and, therefore, thoracic manifestations have continued to change and unexpected complications are being encountered. It has been reported that 33% of HIV-positive children have chronic changes on chest radiographs by the age of 4 years. Lymphocytic interstitial pneumonitis is common in the paediatric HIV population and is responsible for 30-40% of pulmonary disease. HIV-positive children also have a higher incidence of pulmonary malignancies, including lymphoma and pulmonary Kaposi sarcoma. Immune reconstitution inflammatory syndrome is seen after highly active antiretroviral treatment. Complications of pulmonary infections, aspiration and rarely interstitial pneumonitis are also seen. This review focuses on the imaging findings of non-infective chronic pulmonary disease.

The management of children with Kaposi sarcoma in resource limited settings

“…Pleural effusions develop which are often bilateral, bloody and highly proteinaceous. Chest X-ray typically shows bilateral perihilar lymph node enlargement, lower zone parenchymal infiltration and pleural effusions [11]. Lymph nodes (LNs) are commonly involved.…”

Acute cor pulmonale due to lymphocytic interstitial pneumonia in a child with AIDS

“…13,14 children with AiDs are at greater risk of developing pneumonia and more severe diseases than immunocompetent children. [15][16][17] chronic non-infectious lung diseases such as LiP, immune reconstitution inflammatory syndrome, malignant disease, and pneumonitis have also often been reported in older children with AiDs. the most common chronic changes observed in chest radiography are reticular bronchovascular lesions and bronchiectasis.…”

“…the most common chronic changes observed in chest radiography are reticular bronchovascular lesions and bronchiectasis. 17,18 there are few reports about LiP in children with AiDs. the clinical history of recurrent pneumonia leading to changes such as digital clubbing, chest deformity, chronic respiratory failure, and cardiac involvement with signs of cor pulmonale need to be investigated for LiP.…”

The need for bronchoscopic services for children in low and middle-income countries

“…In HIV-infected children, airway obstruction is caused by tumors such as Kaposi sarcomata, viral papillomata, and enlarged mediastinal lymph nodes caused by TB or Cryptococcus neoformans [10,11]. The correct management of these children requires an accurate diagnosis that is best obtained via fiber-optic bronchoscopy.…”

“…In the LMIC, organ transplantation is rarely performed, yet TBB remains a useful procedure to diagnose interstitial lung disease especially in HIV-infected children. Lymphocytic interstitial pneumonitis (LIP) is commonly seen in HIV-positive children, older than 2 years, who have not yet started antiretroviral therapy [11]. LIP's radiological picture overlaps with that of miliary TB making an accurate diagnosis essential.…”