HIV infection leads to a gradual but persistent loss of host immunity that results in a syndrome of immune dysregulation, dysfunction, and deficiency(1). Initial infection with HIV leads to large depletion of CD4+ effector-memory lymphocytes from mucosal-associated lymphoid tissue. There is generalised immune activation leading to progressive decline in naïve and memory T cell pool …
Epidemiology and Risk factors Chronic obstructive pulmonary disease (COPD) is a slowly progressive respiratory disorder that is characterised by incompletely reversible chronic airflow obstruction(18). Smoking is the main risk factor. Other risk factors include occupational exposure to dust and chemicals, indoor air pollution or rarely genetic alpha-1- antitrypsin deficiency (19). Active smoking and frequent exacerbations …
Patients with suspected COPD, based on symptoms of chronic cough, sputum production or dyspnoea should have a spirometry, preferably with bronchodilator testing to determine persistent airflow limitation. The definition of persistent airflow limitation requires that the ratio of the forced expiratory volume in one second (FEV1) to the forced vital capacity (FVC) be less than …
In the absence of specific guidelines on management of COPD in HIV patients, clinicians should follow the management guidelines proposed for the general population. Management of COPD is driven by symptoms and history of exacerbations, rather than the severity of airflow limitation or FEV1% predicted (31). There are a number of symptom assessment tools available …
Both COPD and HIV are associated with increased inflammasome activation, susceptibility to oxidative stress and persistent activation or dysfunction of lung immune cells(29). In addition to environmental risk factors such as smoking or biomass exposure, HIV likely leads to direct cytopathic effect or persistent immune activation which leads to inflammation and increased risk of COPD …
Sarcoidosis is a multisystem granulomatous disorder characterized pathologically by the presence of noncaseating granulomas in involved organs (41). The disease is characterised by bilateral hilar adenopathy, pulmonary infiltrates and possible involvement of the skin, joints, or eyes. The diagnosis of sarcoidosis is established based on compatible clinical and radiologic findings supported by histologic evidence in …
1. Interstitial lung disease (ILD) Interstitial lung diseases such as NSIP and LIP are related to immune dysregulation and are now seen much less frequently due to the use of ART (50). Lymphocytic Interstitial Pneumonitis (LIP) This has been described predominantly in children with low CD4 T -cell counts and is characterised by bilateral reticulonodular …
Crothers K, Thompson BW, Burkhardt K, Morris A, Flores SC, Diaz PT, et al. HIV-associated lung infections and complications in the era of combination antiretroviral therapy. Proc Am Thorac Soc. 2011;8(3):275-81. Chinen J, Shearer WT. Molecular virology and immunology of HIV infection. J Allergy Clin Immunol. 2002;110(2):189-98. Cribbs SK, Crothers K, Morris A. Pathogenesis of …
Developing a sustainable HIV, Viral Hepatitis and Sexual Health Workforce
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