The radiological spectrum of vertically-acquired HIV infection

Abstract

Anonymous antenatal and newborn screening demonstrates a positive HIV seroprevalence of one in 400 in areas of inner city London. European Collaborative Study data show a vertical transmission rate of 15% and suggests that 23% of infected children will develop clinical manifestations of AIDS before reaching 1 year of age [1], meaning that recognition of the radiological findings in vertically-acquired HIV is important. 75 serial cases of vertically-acquired HIV (age range 6 weeks to 12 years, mean age 35 months) presenting to a national referral centre over 48 months were reviewed; the radiographic findings we describe constitute a core of typical abnormalities together with a selection of the rarer manifestations of vertically-acquired HIV.

Imaging of HIV disease in children

“…The most common pulmonary disorders encountered are bacterial pneumonias, PCP and lymphocytic interstitial penumonitis (LIP) [11,12]. Other infections include Mycobacterium tuberculosis (MTB) and Mycobacterium Defined as respiratory failure, oxygen dependence or severe exercise intolerance with oxygen desaturation Severe recurrent bacterial infections Any combination of at least two within a 2-year period: septicaemia, pneumonia, meningitis, osteomyelitis/septic arthritis, abscesses of internal organs Severe failure to thrive/wasting syndrome Crossing at least two percentiles on the growth chart or less than 3rd centile and continuing to deviate from it or .10% loss in body weight in older children HIV encephalopathy At least one of the following findings for at least 2 months in the absence of concurrent illness: (a) failure to attain or loss of developmental milestones; (b) impaired brain growth or brain atrophy.…”

“…Recurrent lower respiratory tract infections and bacterial pneumonias occur more frequently in children than adults with HIV/AIDS, with Streptococcus pneumoniae and Haemophilus influenzae being the most common infecting organisms [11][12][13]. Synchronous multi-organism infections, and infection with unusual organisms such as Salmonella sp., are also more common than in healthy aged-matched controls.…”

“…LIP LIP, also described as pulmonary lymphoid hyperplasia (PLH), is a lymphoroliferative disorder characterized by a diffuse interstitial infiltrate of polyclonal lymphocytes and plasma cells in addition to pulmonary lymphoid hyperplasia [19]. LIP is part of the diffuse infiltrative lymphocytosis syndrome (DILS), where there is infiltration of CD8 T-lymphocytes into the lungs, parotid glands, gastrointestinal tract and skin, and only occurs in those expressing the HLA DR5 alleles [12]. The cause is unknown, however it is thought to represent a direct ''hyperimmune'' lung response to the presence of either HIV or Epstein-Barr virus (EBV) and appears to be associated with a slower rate of disease progression [13,20].…”

“…Lymphadenopathy is common and often becomes more prominent during episodes of superimposed infection ( Figure 5) [11,12]. Chronic LIP often results in patchy fibrosis with secondary traction Imaging of HIV disease in children bronchiectasis [12].…”

“…Lymphadenopathy is common and often becomes more prominent during episodes of superimposed infection ( Figure 5) [11,12]. Chronic LIP often results in patchy fibrosis with secondary traction Imaging of HIV disease in children bronchiectasis [12]. Regression of reticulonodular change may be seen, and either occurs as a consequence of the introduction of triple therapy and/or corticosteroids, or alternatively may indicate immunological deterioration and progression of HIV disease [12].…”