title: Thoracic diseases associated with HIV infection in the era of antiretroviral therapy: clinical and imaging findings.
abstract: The human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) pandemic has entered its 4th decade. Since the introduction of combination antiretroviral therapy (ART) in 1996, the number of AIDS-related deaths has plateaued worldwide. Today, owing to the effectiveness of ART, the HIV-infected population is aging and HIV infection has become a chronic illness. Non-AIDS comorbidities are increasing, and the spectrum of HIV-related thoracic diseases is evolving. In developed countries, bacterial pneumonia has become more common than Pneumocystis pneumonia. Its imaging appearance depends on the responsible organism, most commonly Streptococcus pneumoniae. Mycobacterium tuberculosis continues to be a major threat. Its imaging patterns vary depending on CD4 count. Primary lung cancer and Hodgkin lymphoma are two important non-AIDS-defining malignancies that are increasingly encountered at chest imaging. Human herpesvirus 8, also known as Kaposi sarcoma-associated herpesvirus (KSHV), is strongly linked to HIV-related diseases, including Kaposi sarcoma, multicentric Castleman disease, KSHV inflammatory cytokine syndrome, and primary effusion lymphoma. Immune reconstitution inflammatory syndrome is a direct complication of ART whose manifestations vary with the underlying disease. Given the high rate of smoking among HIV-infected patients, chronic obstructive pulmonary disease is another important cause of morbidity and mortality. A high degree of suspicion is required for the early diagnosis of pulmonary arterial hypertension and lymphocytic interstitial pneumonia, given their nonspecific manifestations. Finally, multilocular thymic cyst manifests as a cystic anterior mediastinal mass. Recognition of the clinical and radiologic manifestations of these less traditional HIV-related diseases can expedite diagnosis and treatment in the ART era.
authors.affiliation: From the Department of Radiology (S.H.S.C., S.J.P., E.J.S., J.D.G., S.N.P.) and Division of Pulmonary and Critical Care Medicine (K.C.), University of Washington, 1959 NE Pacific St, UW Mailbox 357115, Seattle, WA 98195-7115.
authors.forename: Shinn-Huey S
authors.initials: SH
authors.lastname: Chou
authors.forename: Somnath J
authors.initials: SJ
authors.lastname: Prabhu
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Stern
authors.forename: J David
authors.initials: JD
authors.lastname: Godwin
authors.forename: Sudhakar N
authors.initials: SN
authors.lastname: Pipavath
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006566:Herpesviridae Infections / Q000175:diagnosis / Q000821:virology; D019288:Herpesvirus 8, Human; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000175:diagnosis / Q000821:virology; D008175:Lung Neoplasms / Q000175:diagnosis / Q000821:virology; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000821:virology; D013902:Radiography, Thoracic; D013896:Thoracic Diseases / Q000175:diagnosis* / Q000821:virology*; D014057:Tomography, X-Ray Computed
chemical_list: D044966:Anti-Retroviral Agents