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Chest Imaging

E3240. Update on Thoracic Manifestations of HIV

Dettori N,  Kandathil A,  Saboo S,  Rajiah P. Uniersity of Texas Southwestern Medical Center, Dallas, TX

Address correspondence to P. Rajiah (radprabhakar@gmail.com)

Background Information: Because of effective combined anti-retroviral therapy, human immunodeficiency virus (HIV) infection has now become a chronic illness and is associated with prolonged survival. This has led to the development of new comorbidity, not previously encountered in this population. Knowledge of this evolving pattern is essential for early recognition and effective management of the complications of HIV.

Educational Goals/Teaching Points: This aim of this exhibit is to review the thoracic manifestation of HIV infection, recognize the changing patterns of disease with the use of antiretroviral therapy, correlate clinical with radiologic findings, and illustrate the imaging appearances of different pulmonary disorders in HIV.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: We present current trends with antiretroviral therapy for HIV infection, thoracic involvement in HIV, the correlation between CD4 counts and clinical and radiologic presentation, and the role of radiography, CT, MRI, and PET. We offer illustration with case examples of thoracic manifestations of HIV- A including infections of (bacterial pneumonia (Streptococcus, haemophilus, Staphylococcus, pseudomonas, legionella, nocardia, chlamydia, mycoplasma), mycobacterial (reactivation TB); fungal (histoplasmosis, Cryptococcus, aspergillosis), pneumocystis jiroveci pneumonia, viral, and parasitic; neoplasms such as lymphoma (non-Hodgkin, Hodgkin), Kaposi sarcoma, lung cancer, and malignant pleural effusion; smoking-related disorders such as chronic obstructive pulmonary disease (COPD) and bronchogenic neoplasm; cardiovascular complications such as coronary atherosclerosis, pulmonary hypertension, and pericarditis, pericardial effusion; and immune-related and inflammatory changes such as lymphocytic interstitial pneumonia, multicentric Castleman disease, Kaposi sarcoma‚Äďassociated herpesvirus inflammatory cytokine syndrome, and immune reconstitution syndrome. Participants will learn changing patterns with antiretroviral therapy and a diagnostic algorithm.

Conclusion: The spectrum of thoracic manifestations of HIV has evolved because of the use of antiretroviral therapy. As a result, HIV has now become a chronic illness. Bacterial pneumonia is more common than pneumocystic jiroveci pneumonia. Malignancies encountered in HIV include lung cancer, Hodgkin lymphoma, and Kaposi sarcoma. Pulmonary hypertension, COPD, coronary atherosclerosis are also increasingly seen in this population. Recognition of this changing pattern is essential for the radiologist to make an early diagnosis and guide optimal management.