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HIV AND THE LUNGS

Acquired Immune Deficiency Syndrome (AIDS) is the condition that occurs when a person infected with Human Immunodeficiency Virus (HIV) develops symptoms as a result of that infection. These symptoms are much more likely to affect the lungs than any other organ in the body. This pamphlet gives the basic facts about AIDS and the lungs as they are known at present.

What is AIDS?

AIDS is a condition in which the body's immune system is seriously weakened. As a result of this the person is vulnerable to infections and other diseases that would normally be easily resisted.

AIDS is caused by the HIV infection. After someone has been infected by HIV the body produces substances called antibodies after 2-8 weeks. You can ask your medical practitioner for an HIV antibody test to be done.

The presence of HIV antibodies means that a person has been infected with HIV. This does not mean that the person has AIDS. However the Human Immunodefiency Virus often causes progressive damage to the immune system. This can eventually result in the person developing infections or other conditions which are rarely found in people with normal immune systems. The time from infection with the virus to the time when the symptoms of AIDS appear can vary and be many years in some cases.

How are the lungs affected in AIDS?

Lung complications are the most common cause of sickness and death in patients with AIDS. Many different lung problems can occur. These include different types of infection, malignant tumours and various inflammatory diseases as well as localised damage to different parts of the lung. However the most common lung complications are due to lung infections.

Infections

The most common lung infection in patients with AIDS is due to the Pneumocystis Carinii organism. 80% of HIV-infected individuals will experience an episode of this infection at some time. An infection with this organism may be the first sign that a person has AIDS. Pneumocystis is widespread in nature and rarely causes disease except in people such as those with AIDS who have a severe impairment of their immune system. Pneumocystis infection is not passed from one person to another.

People with Pneumocystis lung infection usually develop a dry cough, fevers, sweats, weight loss and breathlessness. It usually comes on slowly over a period of one month although it can develop more rapidly in more severe cases. Patients with this infection will often need to be admitted to hospital for treatment. Antibiotics are usually effective. Because people with HIV are at high risk of contracting this infection, it is now common practice to give regular preventive antibiotics to stop the development of Pneumocystis infection.

Patients with AIDS are unusually susceptible to the bacteria that can cause pneumonia in otherwise healthy people. The symptoms are the same as those in people who do not have AIDS and include fever, cough, breathlessness and pleurisy. The antibiotics used will depend on the type of bacteria causing the infection. These will need to be given in hospital in the more severe cases.

Tuberculosis is an increasing problem in patients with AIDS. Tuberculosis can occur early in the course of HIV illness. In those cases the symptoms are similar to those in otherwise healthy people. Patients with advanced HIV disease more commonly have spread of the infection outside the lungs. They commonly have non-specific symptoms such as a feeling of ill-health, diarrhoea, fevers, sweats and weight loss.

Tuberculosis is the only common HIV-associated infection that is transmitted from person to person. It is therefore essential that it is diagnosed quickly and appropriate treatment given. Proper steps must be taken to prevent spread of the tuberculosis until the patient is no longer contagious.

The treatment of tuberculosis is similar to that recommended for the non-HIV-infected population and consists of a number of drugs given for a minimum of 6 months. There is usually a good response to treatment provided that the treatment is correctly taken and that the AIDS is not too far advanced.

There is another group of organisms that resemble the tuberculosis germ and which cause infection in people with AIDS. These organisms are called MAC organisms (Mycobacterium avium complex). This infection does not usually localise in the lungs in the way that tuberculosis does, but spreads through the body producing non-specific symptoms. It does not pass from one person to another. MAC infections are more difficult to treat than tuberculosis.

There are a number of viral and fungal infections that can occur in HIV-infected individuals. These are less common than the other infections that have been discussed here. They generally have symptoms that are similar to those already described. Specific treatment is available for many of these infections but this usually has to be given in hospital.

How are lung infections diagnosed?

The presence of a lung infection can usually be diagnosed by a doctor examining the chest and looking at a chest x-ray. However the cause of the infection depends on identifying the responsibile germ or infectious agent. This can sometimes be done by testing samples of the sputum but this is often not sensitive enough. In such cases a sample of sputum can be induced by having the person inhale a special saline solution from a nebuliser. If the cause of the infection remains unclear it may be necessary to do a test called a bronchoscopy.

Malignant tumours

The most common malignancy in HIV-infected individuals is Kaposi's sarcoma. This condition most commonly affects the skin and produces purple-coloured patches. It can also affect the internal organs with the lungs being affected in about one third of cases. Cough is then the most common symptom. The chest x-ray is usually abnormal but the condition can only be diagnosed on a biopsy from the lungs or other affected organs. Drug treatment (chemotherapy) is available for Kaposi's sarcoma and there may be improvement in the patient's condition, but the drugs cannot cure Kaposi's sarcoma.

Other types of malignancy occur more commonly in HIV-infected individuals. The most common of these is lymphoma (tumours of white blood cells known as lymphocytes). These affect the lungs in only a few patients.

Breathlessness in patients with AIDS

There are many reasons why patients with AIDS may become breathless. The breathlessness may be caused by a specific infection as outlined in this leaflet. Other causes include reactions to drugs, other unrelated conditions (such as asthma), anaemia, lung damage or scarring resulting from previous infections and some rare inflammatory reactions in the lung.

Chest x-rays and breathing tests will usually be necessary before the cause of breathlessness can be diagnosed.

What should a person with AIDS do if breathlessness or cough develops?

Any person with AIDS who develops breathlessness, cough or wheezing should consult their medical practitioner so that appropriate tests can be done to determine the cause of the problem. Once this has been done correct treatment and advice can be given. The symptoms will not necessarily be due to a serious underlying problem but, if there is an underlying infection present, the sooner it is diagnosed and treated, then the greater the likelihood of a successful treatment. Spontaneous improvement of these problems is rare and delay usually means that more prolonged treatment is needed to obtain improvement. If there are long delays in seeking help then the outcome of treatment may be uncertain.

Please Note: This information is intended by The Australian Lung Foundation to be used as a guide only and is not an authoritative statement. Please consult your family doctor or specialist respiratory physician if you have further questions relating to the information provided here.

© 1996, The Australian Lung Foundation