HIV-related Pneumonias
Respiratory (12%) Core Clinical Conditions
2B The Physician Associate is able to undertake the day to day management of the patient and condition once the diagnosis and strategic management decisions have been made by another.
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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management
Definition
Pneumonia that occurs in individuals that are infected with the human immunodeficiency virus (HIV).
Aetiology
Pneumocystis pneumonia: caused by a fungus called Pneumocystis jirovecii.
Bacterial pneumonia: caused by Streptococcus pneumoniae and Haemophilus influenzae.
Tuberculosis (TB): caused by the bacteria Mycobacterium tuberculosis.
Viral pneumonias: caused by respiratory syncytial virus (RSV), influenza, and cytomegalovirus (CMV).
Other fungal pneumonias: such as Cryptococcus neoformans and Histoplasma capsulatum.
Pathophysiology
Pneumocystis pneumonia: caused by Pneumocystis jirovecii > opportunistic as there are low levels of CD4+ T cells > proliferation in lungs, causing damage to alveoli and impairs the lung’s gas exchange ability.
Bacterial pneumonia: caused by Streptococcus pneumoniae and Haemophilus influenzae. Low immune system > bacterial colonise the lungs.
Tuberculosis (TB): same as bacteria pneumonia.
Viral pneumonias: caused by respiratory syncytial virus (RSV), influenza, and cytomegalovirus (CMV). These viruses cause inflammation + damage to respiratory epithelium.
Risk factors
HIV infection.
Low CD4+ T cell count.
Non adherence to treatment.
Exposure to pathogens.
IV drug use e.g. sharing needles.
Smoking.
Poor socio economic conditions.
Sign and symptoms
Fever,
Cough, persistent cough + productive.
Shortness of breath, chest pain, rapid breathing (tachypnea).
Fatigue, night sweats, weight loss.
Diagnosis and investigations
CT scan.
Chest X-ray.
CT Scan.
Sputum culture.
Management
Medication treatment: antibiotics, antifungals, or antiviral drugs depending on cause.
Antiretroviral therapy (ART): main treatment to control HIV replication, improve immune function, and reduce the risk of opportunistic infections, including pneumonias. This is generally started by a specialist.
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