HIV pulmonary complications - Revision history

Danbot: Strip excess bold

2026-03-22T09:28:52Z

Strip excess bold

Danbot: Expand: CD4-stratified differential, CXR patterns, PCP evaluation, PORT score caveat

2026-03-21T01:44:28Z

Expand: CD4-stratified differential, CXR patterns, PCP evaluation, PORT score caveat

← Revisión anterior		Revisión del 01:44 21 mar 2026
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	==Background==		==Background==
	*Most common cause of pneumonia in HIV~~-infected patient is~~ [[Strep pneumo]] (not [[PCP]])		*Pulmonary disease is the most common reason for hospitalization in HIV/AIDS patients
			*'''Most common cause of pneumonia in HIV:''' [[Strep pneumo\|''Streptococcus pneumoniae'']] (not [[PCP]])
			*Risk of opportunistic infections increases as CD4 count declines:
			**CD4 >200: Bacterial pneumonia, [[tuberculosis]]
			**CD4 <200: [[PCP\|Pneumocystis jirovecii pneumonia (PCP)]]
			**CD4 <100: Fungal infections (histoplasmosis, coccidioidomycosis), [[Mycobacterium avium complex]]
			**CD4 <50: CMV pneumonitis

	==Clinical Features==		==Clinical Features==
			*Varies by organism:
			**'''Bacterial:''' Acute onset, productive cough, fever, focal consolidation
			**'''PCP:''' Subacute (weeks), dry cough, progressive dyspnea on exertion, [[hypoxia]] out of proportion to exam, bilateral diffuse infiltrates
			**'''TB:''' Chronic cough, night sweats, weight loss; may have upper lobe cavitary disease or atypical patterns with low CD4
			**'''Kaposi sarcoma (pulmonary):''' Dyspnea, hemoptysis; skin/mucosal lesions often present

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	*[[~~ABG~~]]		*[[CXR]] — essential first step:
	*~~Sputum culture~~, ~~gram stain~~, ~~AFB~~		**Lobar consolidation → bacterial
	*[[~~Blood~~ cultures]]		**Bilateral diffuse interstitial/ground-glass → PCP
	*[[~~CXR~~]]		**Upper lobe cavitary disease → TB
			**Nodules, pleural effusions → fungal, TB, lymphoma, [[Kaposi sarcoma]]
			*[[ABG]]/SpO2 — resting and with exertion (PCP may show desaturation only with ambulation)
			*Labs: CBC, LDH (elevated in PCP), CD4 count, [[blood cultures]], sputum (Gram stain, culture, AFB)
			*Induced sputum for PCP (silver stain or DFA)
			*CT chest if CXR non-diagnostic
			*'''Cannot use [[PORT score]]''' to disposition HIV patients (not validated in this population)

	==Management==		==Management==
			*Treat based on suspected organism; see individual disease pages for antibiotic templates
			*'''Always isolate''' until TB ruled out (negative AFB × 3 or clinical exclusion)
			*Start empiric antibiotics for bacterial pneumonia per standard CAP guidelines while workup pending
			*Low threshold for ICU admission — HIV patients decompensate rapidly

	==Disposition==		==Disposition==
	*~~Cannot use [[PORT score]] to disposition~~ patients		*Low threshold for admission; most HIV patients with pneumonia require inpatient treatment
			*ICU for respiratory failure, severe hypoxia, hemodynamic instability

	==See Also==		==See Also==
			*[[HIV - AIDS (Main)]]
	~~==External Links==~~		*[[PCP]]
			*[[Tuberculosis]]
			*[[Community acquired pneumonia]]
			*[[Neutropenic fever]]

	==References==		==References==

Rossdonaldson1 at 10:00, 30 July 2016

2016-07-30T10:00:13Z

← Revisión anterior		Revisión del 10:00 30 jul 2016
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	==Background==		==Background==
	*Most common cause of pneumonia in HIV-infected patient is Strep pneumo~~, NOT~~ PCP		*Most common cause of pneumonia in HIV-infected patient is [[Strep pneumo]] (not [[PCP]])

	==Clinical Features==		==Clinical Features==
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	==Evaluation==		==Evaluation==
	**ABG		*[[ABG]]
	**Sputum culture, gram stain, AFB		*Sputum culture, gram stain, AFB
	**Blood cultures		*[[Blood cultures]]
	**CXR		*[[CXR]]
	*Specific Infections
	**[[Pneumocystis Pneumonia (PCP)]]
	**[[~~Tuberculosis (TB)~~]]

	==Management==		==Management==

	==Disposition==		==Disposition==
	*Cannot use PORT score to ~~dispo~~ patients		*Cannot use [[PORT score]] to disposition patients

	==See Also==		==See Also==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-23T08:34:49Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 08:34 23 jul 2016
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	{{HIV associated conditions}}		{{HIV associated conditions}}

	==~~Diagnosis~~==		==Evaluation==
	**ABG		**ABG
	**Sputum culture, gram stain, AFB		**Sputum culture, gram stain, AFB

ClaireLewis: /* Diagnosis */

2016-07-15T00:31:29Z

Diagnosis

← Revisión anterior		Revisión del 00:31 15 jul 2016
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	==Diagnosis==		==Diagnosis==
	**ABG		**ABG
	**Sputum cx, GS, AFB		**Sputum culture, gram stain, AFB
	**Blood cx		**Blood cultures
	**CXR		**CXR
	*Specific Infections		*Specific Infections

ClaireLewis: /* Background */

2016-07-14T02:25:03Z

Background

← Revisión anterior		Revisión del 02:25 14 jul 2016
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	==Background==		==Background==
	*Most common cause of ~~PNA~~ in HIV-infected patient is Strep pneumo, NOT PCP		*Most common cause of pneumonia in HIV-infected patient is Strep pneumo, NOT PCP

	==Clinical Features==		==Clinical Features==

Neil.m.young: Text replacement - " pt " to " patient "

2016-07-02T13:37:27Z

Text replacement - " pt " to " patient "

← Revisión anterior		Revisión del 13:37 2 jul 2016
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	==Background==		==Background==
	*Most common cause of PNA in HIV-infected pt is Strep pneumo, NOT PCP		*Most common cause of PNA in HIV-infected patient is Strep pneumo, NOT PCP

	==Clinical Features==		==Clinical Features==

Ostermayer: Text replacement - " pts" to " patients"

2016-06-21T16:50:50Z

Text replacement - " pts" to " patients"

← Revisión anterior		Revisión del 16:50 21 jun 2016
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	==Disposition==		==Disposition==
	*Cannot use PORT score to dispo ~~pts~~		*Cannot use PORT score to dispo patients

	==See Also==		==See Also==

Ostermayer: Text replacement - "Category:Pulm" to "Category:Pulmonary"

2016-03-22T16:12:17Z

Text replacement - "Category:Pulm" to "Category:Pulmonary"

← Revisión anterior		Revisión del 16:12 22 mar 2016
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	[[Category:ID]]		[[Category:ID]]
	[[Category:~~Pulm~~]]		[[Category:Pulmonary]]

Zipdoc at 06:54, 4 August 2015

2015-08-04T06:54:06Z

← Revisión anterior		Revisión del 06:54 4 ago 2015
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	==References==		==References==
	<references/>		<references/>

			[[Category:ID]]
			[[Category:Pulm]]

← Revisión anterior		Revisión del 09:28 22 mar 2026
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	==Background==		==Background==
	*Pulmonary disease is the most common reason for hospitalization in HIV/AIDS patients		*Pulmonary disease is the most common reason for hospitalization in HIV/AIDS patients
	*~~'''~~Most common cause of pneumonia in HIV:~~'''~~ [[Strep pneumo\|''Streptococcus pneumoniae'']] (not [[PCP]])		*Most common cause of pneumonia in HIV: [[Strep pneumo\|''Streptococcus pneumoniae'']] (not [[PCP]])
	*Risk of opportunistic infections increases as CD4 count declines:		*Risk of opportunistic infections increases as CD4 count declines:
	**CD4 >200: Bacterial pneumonia, [[tuberculosis]]		**CD4 >200: Bacterial pneumonia, [[tuberculosis]]
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	==Clinical Features==		==Clinical Features==
	*Varies by organism:		*Varies by organism:
	**~~'''~~Bacterial:~~'''~~ Acute onset, productive cough, fever, focal consolidation		**Bacterial: Acute onset, productive cough, fever, focal consolidation
	**~~'''~~PCP:~~'''~~ Subacute (weeks), dry cough, progressive dyspnea on exertion, [[hypoxia]] out of proportion to exam, bilateral diffuse infiltrates		**PCP: Subacute (weeks), dry cough, progressive dyspnea on exertion, [[hypoxia]] out of proportion to exam, bilateral diffuse infiltrates
	**~~'''~~TB:~~'''~~ Chronic cough, night sweats, weight loss; may have upper lobe cavitary disease or atypical patterns with low CD4		**TB: Chronic cough, night sweats, weight loss; may have upper lobe cavitary disease or atypical patterns with low CD4
	**~~'''~~Kaposi sarcoma (pulmonary):~~'''~~ Dyspnea, hemoptysis; skin/mucosal lesions often present		**Kaposi sarcoma (pulmonary): Dyspnea, hemoptysis; skin/mucosal lesions often present

	==Differential Diagnosis==		==Differential Diagnosis==
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	*Induced sputum for PCP (silver stain or DFA)		*Induced sputum for PCP (silver stain or DFA)
	*CT chest if CXR non-diagnostic		*CT chest if CXR non-diagnostic
	*~~'''~~Cannot use [[PORT score]]~~'''~~ to disposition HIV patients (not validated in this population)		*Cannot use [[PORT score]] to disposition HIV patients (not validated in this population)

	==Management==		==Management==
	*Treat based on suspected organism; see individual disease pages for antibiotic templates		*Treat based on suspected organism; see individual disease pages for antibiotic templates
	*~~'''~~Always isolate~~'''~~ until TB ruled out (negative AFB × 3 or clinical exclusion)		*Always isolate until TB ruled out (negative AFB × 3 or clinical exclusion)
	*Start empiric antibiotics for bacterial pneumonia per standard CAP guidelines while workup pending		*Start empiric antibiotics for bacterial pneumonia per standard CAP guidelines while workup pending
	*Low threshold for ICU admission — HIV patients decompensate rapidly		*Low threshold for ICU admission — HIV patients decompensate rapidly