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 …
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 …
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 …
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 …
Bruce J. Brew Immunology/HIV/Infectious Diseases Clinical Services Unit and Department of Neurology, St Vincent’s Hospital, Sydney NSW Zachary J. Webb-Harvey Immunology/HIV/Infectious Diseases Clinical Services Unit, St Vincent’s Hospital, Sydney NSW When evaluating neurological presentations in context of HIV (Human immunodeficiency virus) the differential diagnosis is determined by the stage of HIV infection, previous treatment history, …
Bruce J. Brew Immunology/HIV/Infectious Diseases Clinical Services Unit and Department of Neurology, St Vincent’s Hospital, Sydney NSW Zachary J. Webb-Harvey Immunology/HIV/Infectious Diseases Clinical Services Unit, St Vincent’s Hospital, Sydney NSW Neurological complications of HIV (Human immunodeficiency virus) continue to commonly impact people living with HIV (PLWH) in the post combined antiretroviral therapy (cART) era. The …
HIV associated neurocognitive disorder HIV associated neurocognitive disorder (HAND) represents a significant burden upon PLWH in the post cART era. In a metanalysis of 35,513 PLWH, HAND is reported at a prevalence of 42.6% (1), though it is less common in those with sustained viral suppression and early institution of cART. HAND adversely impacts PWLH …