In patients infected with HIV, respiratory disorders can occur in the absence of identifiable infection or neoplasms. As a cause of these non-specific pulmonary manifestations both Epstein Barr virus and HIV-I have been implicated. Numerous recent advances have been made in our understanding through morphological and functional studies on cell populations recovered in bronchoalveolar lavage (BAL) fluid from patients infected with HIV. Data now suggest a sequence starting with HIV infection of lung cells leading to a specific cytotoxic immune response; hence to local damage within the lung and deterioration in the alveolar capillary barrier.' The sequence of events remains to an extent conjectural. This editorial reviews the evidence for HIV infection in the lung and its possible direct and indirect consequences.

https://thorax.bmj.com/content/thoraxjnl/48/12/1191.full.pdf

HIV in the lung: guilty or not guilty?

Background: The impact of the human immunodeficiency virus (HIV) infection on the respiratory system of Africans has been little studied. This study aimed to determine the pattern of respiratory symptoms and ventilatory functions in HIV infected Nigerians. Methods: In this cross sectional study, Respiratory symptoms frequency, Forced vital capacity (FVC), Forced expiratory volume in one second (FEV 1 ), FEV 1 /FVC ratio, Forced expiratory flow between 25% and 75% of FVC, were determined in 100 HIV positive subjects and compared with values in 100 HIV negative controls. Results: HIV positive patients had significantly more respiratory symptoms and lower ventilatory function tests values compared to the matched controls (p<0.05). HIV patients with at least one respiratory symptom and those with CD4 count less than 200cells/µl had lower ventilatory function values than their counterparts. 32% of the HIV patients had restrictive ventilatory functional impairment. (p<0.05). Using regression analysis, factors like HIV status, CD4 count and presence of respiratory symptoms were found to be associated with impairment in ventilatory functions. Conclusions: HIV infected patients had more frequent respiratory symptoms and lower ventilatory function values. Further lung function studies and CT scanning in HIV positive patients especially in those with respiratory symptoms are indicated.

/pdf/respiratory-symptoms-and-ventilatory-function-tests-in-ouw6t6pg9v.pdf

Respiratory symptoms and ventilatory function tests in Nigerians with HIV infection.

Healthy HIV-positive regular donors of plasma in a programme of passive immunotherapy for AIDS patients were studied over a period of about two years. None developed symptoms of clinical progression; most seemed to make substantial gains of CD4 cells by comparison with asymptomatic individuals who were not donating. The effects of donation did not seem to diminish with repetition, and donor CD4 counts tended towards stabilizing within normal limits. Asymptomatic HIV-positive individuals were compared immunologically with 'normals' and people with AIDS, using a battery of 25 measurements on peripheral blood. The immunological profiles of donor and non-donor asymptomatics, indistinguishable at the start, became dissimilar: donors' profiles resembled AIDS less, non-donors became less like 'normal' and a few non-donor results could not be distinguished from AIDS. Improvement in the CD4 counts and amelioration of the immunological profile in donors provide prima facie evidence that plasmapheresis may be therapeutic for asymptomatic HIV-positive people. Further studies are justified.

/pdf/can-repeated-plasma-donation-by-asymptomatic-hiv-infected-1yi2r4inok.pdf

Can repeated plasma donation by asymptomatic HIV–infected individuals delay the onset of AIDS?

A retrospective study on 202 consecutive patients with HIV infection was reviewed. A particular syndrome with blood CD8 lymphocytosis > 1 500/mm3, associated with a diffuse lymphocytic infiltrate histologically proved in the tissue of different organs was present in five patients. Clinical findings were variable, depending on the location of visceral infiltrate by activated, polyclonal lymphocytes of CD8 phenotype: interstitial pneumonia (n = 3), parotid gland enlargement with sicca syndrome (n = 2), pseudo-tumoral splenomegaly (n = 1), peripheral neuropathy (n = 1), superficial generalized lymphadenopathy (n = 5). This syndrome occurred early during HIV infection. All patients had a blood CD4 lymphocyte count > 200/mm3. This disorder is a host immune response, sometimes associated with the presence of some HLA antigens: HLA-DR5 or HLA A1 B8 DR3. Whether this immune response is specific or not, whether outcome of HIV infection depends on hyper CD8 lymphocytosis remains to be proved.

Syndrome d'hyperlymphocytose CD8 et infection par le virus de l'immunodéficience humaine : cinq observations

SUMMARY Healthy HIV-positive regular donors of plasma in a programme of passive immunotherapy for AIDS patients were studied over a period of about two years None developed symptoms of clinical progression; most seemed to make substantial gains of CD4 cells by comparison with asymptomatic individuals who were not donating The eects of donation did not seem to diminish with repetition, and donor CD4 counts tended towards stabilizing within normal limits Asymptomatic HIV-positive individuals were compared immunologically with ‘normals’ and people with AIDS, using a battery of 25 measurements on peripheral blood The immunological profiles of donor and non-donor asymptomatics, indistinguishable at the start, became dissimilar: donors’ profiles resembled AIDS less, non-donors became less like ‘normal’ and a few non-donor results could not be distinguished from AIDS Improvement in the CD4 counts and amelioration of the immunological profile in donors provide prima facie evidence that plasmapheresis may be therapeutic for asymptomatic HIV-positive people Further studies are justified

Can repeated plasma donation by asymptomatic HIV- infected individuals delay the onset of AIDS?

Broncho-alveolar lavage was performed to assess the degree of pulmonary lymphocytic alveolitis in 32 asymptomatic patients who were infected with the Human Immunodeficiency Virus (VIH). The patients were stages II and III of the CDC classification and the aim of the study was to determine the frequency, nature and prognostic role of the findings. 62.5% of the subjects (20/32) presented with a lymphocytic alveolitis which consisted predominantly of CD8 lymphocyte (64.3 +/- 3.5%), in the absence of an opportunistic infection or broncho-pulmonary tumours. Two sub-populations of alveolar CD8 were shown at comparable levels, a) sub-population CD8+D44+ (22.1 +/- 5%), in whom we showed the possession of cytotoxic activity in particular specific for VIH; b) sub-population CD8+CD57+ (19.6 +/- 3%) which we have shown to be capable in vitro of inhibiting the effector phase of cytotoxic activity of CD8+D44+ alveolar cells specific for VIH. In this group of 32 patients the occurrence of an alveolitis was not correlated with the usual prognostic factors of infection by VIH measured simultaneously with broncho-alveolar lavage (the level of CD4+ blood lymphocytes, and the beta 2-plasma microglobulins and the presence of p24 antigenaemia). In addition the level of CD4 lymphocytes supperior to 400/mm3 and of beta 2-microglobulins less then 3 mg/l whether a lymphocytic alveolitis was there or not confirmed the relatively poorly developed state of the VIH infection in these asymptomatic patients. Also the occurrence of a lymphocytic alveolitis did not seem to be linked to progression of the disease in the group of patients studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Quint L

Papers

[Lymphocytic alveolitis in the early stages of HIV infection: correlation with biological and prognostic factors].