Pulmonary manifestations of acquired immunodeficiency syndrome

In at least 65 % of patients with acquired immunodeficiency syndrome (AIDS), the lung is the site for life-threatening illness. To establish a basis for understanding the pulmonary pathology of such illness, we first review briefly the effects of the human immunodeficiency virus on the immune system and then review the pathological pulmonary processes occurring in AIDS in terms of their various etiologies: infections, idiopathic processes, and neoplasia. In the section on each etiology, we discuss clinical manifestations, pulmonary pathology, diagnostic findings, and therapeutic options. In the last section, we outline our overall initial diagnostic approach to the patient with AIDS who presents with respiratory symptoms, and we discuss the integration of clinical, laboratory, and radiographic findings. Acquired immunodeficiency syndrome (AIDS) has reached epidemic proportions in the United States, with--1.5 million Americans thought to be infected with the caus-ative agent, human immunodeficiency virus (HIV). The pro-jections for 1991-10 years after the original description of the syndrome-were for 271,000 cases and 170,000 deaths [1]. The clinical case definition of AIDS [2, 3] includes th