Pulmonary Infection in HIV AIDS Patients.
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
Pulmonary Infection in HIV AIDS Patients
Anak Agung Ayu Yuli Gayatri, Tuti Parwati Merati
Division of Tropical and Infectious Disease
Department of Internal Medicine
Udayana University School of Medicine-Sanglah Hospital Denpasar
Abstract
The immune dysregulation associated with HIV result in an increased incidence of
respiratory infection at all CD4 T-cell count. The type of pulmonary condition to be
developed by AIDS patients will depend on the stage of disease, which is generally
determine based on the CD4 lymphocytes count. Some of the most common opportunistic
infectious lung diseases seen in HIV-positive or AIDS patients are pneumocystis carinii
pneumonia, tuberculosis and bacterial pneumonia. A simple patient risk assessment
allows the clinician to determine the likelyhood that other opportunistic infections are the
cause of severe respiratory disease and that further pathogens may need to be
considered. Treatment is often started prior to laboratory confirmation of diagnosis. The
intensity with which investigation is undertaken is usually determined by the patient risk
assessment, severity of the illness and the resources available locally.
Keywords :
Immunocompromised patient, HIV,
tuberculosis, bacterial pneumonia
pneumocystis
carinii
pneumonia,
pulmonary
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
Introduction
Human Immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency
syndrome (AIDS). HIV targets an important kind of white blood cell called CD-4 T
Lymphocyte or T cells. T cells belong to the immune system and protect the body from
germs and other disease-causing agents. Germs take this opportunity to invade the body
and cause infections. People may be infected with HIV for years before developing AIDS.
The lung is a major area of opportunistic infection in people living with HIV and AIDS.
Some of the most common opportunistic infectious diseases seen in HIV-positive or AIDS
patients are pneumocystis carinii pneumonia, tuberculosis and bacterial pneumonia.
(Dockrell DH et al. 2011)
A simple patient risk assessment allows the clinician to determine the likelyhood that other
opportunistic infections are the cause of severe respiratory disease and that further
pathogens may need to be considered. Relevant factors include: (1) patient use of
effective opportunistic infection prophylaxis or HAART; (2) from hospital or current hospital
admission >5 days (nosocomial infections); (3) country/place of residence and travel
history; (4) history of active injecting drug use, since these individuals are at increase risk
of bacterial pneumonia and TB; (5) level of host immunity; (6) neutropenia; (7) use of
prolong course of immune modulator (e.g. corticosteroids).
Pneumocystis carinii pneumonia (PCP)
Pneumocystis carinii pneumonia (PCP) is the first sign of illness in more than half of all
persons with AIDS in the United States. This is caused by the Pneumocyctis jiroveci germ,
formerly known as Pneumocystis carinii. Pneumocystis jirovecii is a fungus that causes
infection specific to humans. The great majority occur in immunocompromised subjects
and are associated with respiratory symptoms. Many people who are HIV positive take
medication to prevent PCP; frequent blood tests help health care provider decided when
such treatment should begin.
Presentation
Without preventive medicine, over 80% of people with HIV will likely get PCP. Common
symptoms include coughing, fever and trouble breathing. Almost 90% of cases occur in
HIV-seropositive persons with CD4 T-cell counts 9.3kPA (>70 mmHg)], dosing
is either via the oral route (TMPSMX 1920 mg tid or 90 mg/kg/day tid) or using the iv
regimen describe above. The dose reduction from 120 mg/kg/day to 90mg/kg/day, in
severe disease has equivalent efficacy but lower incidence of advers events than
continuous use of higher-dose therapy. Some clinicians will continue with iv therapy for the
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
duration; many switch individuals showing a good initial response to oral therapy at doses
equivalent to those used for mild-moderate severity disease. Individuals with a PaO2
200 cells/µL, every effort should be made to confirm a
specific diagnosis in the more immunocompromised individual. Initial anti-microbial
treatment is usually empirical and should be chosen according to; (a) pneumonia severity;
(b)the likelyhood of particular pathogens as indicated by risk factors; (c) the potential for
antibiotic resistant and (d) potential toxicities. A number of guidelines developed to guide
the management of CAP in HIV-seronegative individuals exist and the possible regimens
suggested in these guidelines are adapted from them. HIV-seropositive individuals with
community-acquired pneumonia should be treated as per HIV-seronegative populations.
Antibiotic prophylaxis is not indicated for bacterial pneumonia. The capsular
polysaccharide vaccine protects against pneumococcal serotypes. The Departement of
Health includes HIV-seropositive individuals amongst the “high- risk” groups for whom
vaccination is recommended.
References
Beck J. Immunocompromised Host. Proc Am Thorax Soc 2005;2:423-7
Benson CA et al. Treating Opportunistic Infections Among HIV Infected Adults and
Adolescents Recommendations from CDC, the National Institutes of Health, and the HIV
Medicine Association/ InfectiousDiseases Society of America. Available at: http:
//www.cdc.gov/hiv/topics/treatment/index.htm
Dockrell DH, Breen R, Lipman M, Miller RF. Pulmonary Opportunistic infections. 2011. HIV
Medicine. 12 (suppl.2) 25-42.
Dunleavy A, Lipman M, Miller R. Infection in the HIV compromised host. In: maskell N,
Millar A, eds. Oxford Desk Reference Respiratory Medicine. Oxford, Oxford University
Press. 2009: 210-217
Lawn S. Churchyard G. Epidemiology of HIV associated tuberculosis. Curr Opin HIV AIDS
2009;4:325-33
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
Padmapriyadarsini C, Narendran G, Swaminathan S. Diagnosis & Treatment of
Tuberculosis in HIV co-invected patients. 2011. Indian J Med Res 134;850-865
Tuberkulosis, Pedoman Diagnosis dan Penatalaksanaan di Indonesia. 2011. Perhimpunan
Dokter Paru Indonesia.
WHO
report
2010.
Global
tuberculosis
control.
Available
http://whqlibdoc.who.int/publications/2010/9789241564069_eng.pdf,accessed
September 20,2011.
from:
on
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
Pulmonary Infection in HIV AIDS Patients
Anak Agung Ayu Yuli Gayatri, Tuti Parwati Merati
Division of Tropical and Infectious Disease
Department of Internal Medicine
Udayana University School of Medicine-Sanglah Hospital Denpasar
Abstract
The immune dysregulation associated with HIV result in an increased incidence of
respiratory infection at all CD4 T-cell count. The type of pulmonary condition to be
developed by AIDS patients will depend on the stage of disease, which is generally
determine based on the CD4 lymphocytes count. Some of the most common opportunistic
infectious lung diseases seen in HIV-positive or AIDS patients are pneumocystis carinii
pneumonia, tuberculosis and bacterial pneumonia. A simple patient risk assessment
allows the clinician to determine the likelyhood that other opportunistic infections are the
cause of severe respiratory disease and that further pathogens may need to be
considered. Treatment is often started prior to laboratory confirmation of diagnosis. The
intensity with which investigation is undertaken is usually determined by the patient risk
assessment, severity of the illness and the resources available locally.
Keywords :
Immunocompromised patient, HIV,
tuberculosis, bacterial pneumonia
pneumocystis
carinii
pneumonia,
pulmonary
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
Introduction
Human Immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency
syndrome (AIDS). HIV targets an important kind of white blood cell called CD-4 T
Lymphocyte or T cells. T cells belong to the immune system and protect the body from
germs and other disease-causing agents. Germs take this opportunity to invade the body
and cause infections. People may be infected with HIV for years before developing AIDS.
The lung is a major area of opportunistic infection in people living with HIV and AIDS.
Some of the most common opportunistic infectious diseases seen in HIV-positive or AIDS
patients are pneumocystis carinii pneumonia, tuberculosis and bacterial pneumonia.
(Dockrell DH et al. 2011)
A simple patient risk assessment allows the clinician to determine the likelyhood that other
opportunistic infections are the cause of severe respiratory disease and that further
pathogens may need to be considered. Relevant factors include: (1) patient use of
effective opportunistic infection prophylaxis or HAART; (2) from hospital or current hospital
admission >5 days (nosocomial infections); (3) country/place of residence and travel
history; (4) history of active injecting drug use, since these individuals are at increase risk
of bacterial pneumonia and TB; (5) level of host immunity; (6) neutropenia; (7) use of
prolong course of immune modulator (e.g. corticosteroids).
Pneumocystis carinii pneumonia (PCP)
Pneumocystis carinii pneumonia (PCP) is the first sign of illness in more than half of all
persons with AIDS in the United States. This is caused by the Pneumocyctis jiroveci germ,
formerly known as Pneumocystis carinii. Pneumocystis jirovecii is a fungus that causes
infection specific to humans. The great majority occur in immunocompromised subjects
and are associated with respiratory symptoms. Many people who are HIV positive take
medication to prevent PCP; frequent blood tests help health care provider decided when
such treatment should begin.
Presentation
Without preventive medicine, over 80% of people with HIV will likely get PCP. Common
symptoms include coughing, fever and trouble breathing. Almost 90% of cases occur in
HIV-seropositive persons with CD4 T-cell counts 9.3kPA (>70 mmHg)], dosing
is either via the oral route (TMPSMX 1920 mg tid or 90 mg/kg/day tid) or using the iv
regimen describe above. The dose reduction from 120 mg/kg/day to 90mg/kg/day, in
severe disease has equivalent efficacy but lower incidence of advers events than
continuous use of higher-dose therapy. Some clinicians will continue with iv therapy for the
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
duration; many switch individuals showing a good initial response to oral therapy at doses
equivalent to those used for mild-moderate severity disease. Individuals with a PaO2
200 cells/µL, every effort should be made to confirm a
specific diagnosis in the more immunocompromised individual. Initial anti-microbial
treatment is usually empirical and should be chosen according to; (a) pneumonia severity;
(b)the likelyhood of particular pathogens as indicated by risk factors; (c) the potential for
antibiotic resistant and (d) potential toxicities. A number of guidelines developed to guide
the management of CAP in HIV-seronegative individuals exist and the possible regimens
suggested in these guidelines are adapted from them. HIV-seropositive individuals with
community-acquired pneumonia should be treated as per HIV-seronegative populations.
Antibiotic prophylaxis is not indicated for bacterial pneumonia. The capsular
polysaccharide vaccine protects against pneumococcal serotypes. The Departement of
Health includes HIV-seropositive individuals amongst the “high- risk” groups for whom
vaccination is recommended.
References
Beck J. Immunocompromised Host. Proc Am Thorax Soc 2005;2:423-7
Benson CA et al. Treating Opportunistic Infections Among HIV Infected Adults and
Adolescents Recommendations from CDC, the National Institutes of Health, and the HIV
Medicine Association/ InfectiousDiseases Society of America. Available at: http:
//www.cdc.gov/hiv/topics/treatment/index.htm
Dockrell DH, Breen R, Lipman M, Miller RF. Pulmonary Opportunistic infections. 2011. HIV
Medicine. 12 (suppl.2) 25-42.
Dunleavy A, Lipman M, Miller R. Infection in the HIV compromised host. In: maskell N,
Millar A, eds. Oxford Desk Reference Respiratory Medicine. Oxford, Oxford University
Press. 2009: 210-217
Lawn S. Churchyard G. Epidemiology of HIV associated tuberculosis. Curr Opin HIV AIDS
2009;4:325-33
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
Padmapriyadarsini C, Narendran G, Swaminathan S. Diagnosis & Treatment of
Tuberculosis in HIV co-invected patients. 2011. Indian J Med Res 134;850-865
Tuberkulosis, Pedoman Diagnosis dan Penatalaksanaan di Indonesia. 2011. Perhimpunan
Dokter Paru Indonesia.
WHO
report
2010.
Global
tuberculosis
control.
Available
http://whqlibdoc.who.int/publications/2010/9789241564069_eng.pdf,accessed
September 20,2011.
from:
on
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015
BIDS-7 dan BAMHOI-3, Widhya Sabha, Denpasar 21 November 2015