Human immunodeficiency-virus-related pulmonary infections in children

Increasing numbers of children with human immunodeficiency virus (HIV) infection continue to be seen in the United States. Pulmonary infections constitute a major cause of morbidity and mortality in these children. Pneumoncystis carinii pneumonia, pulmonary lymphoid hyperplasia/lymphoid interstitial pneumonitis, and bacterial pneumonias, all described in high frequency in the earliest cases of pediatric acquired immunodeficiency syndrome, remain the pulmonary diseases confronted most often. Other pathogens, such as Mycobacterium tuberculosis and respiratory virus infections are now being identified in increasing numbers in HIV-infected children. Advances in our understanding of these disease processes and their clinical manifestations have allowed development of a systematic approaches to the common problem of the HIV-infected child with fever, tachypnea, and hypoxemia and an abnormal chest radiograph. These approaches, coupled with improvements in available treatment options, have led to earlier diagnosis and improved survival. Prophylaxis strategies have been developed for the most serious pulmonary infections, especially P carinii pneumonia. However, lack of identification of infants and children at risk of HIV infection has limited their effectiveness. Pulmonary infections in HIV-infected children continue to take a high toll with regard to morbidity and mortality. Only with continued advances in primary therapy to slow progression of the underlying immunodeficiency and widespread use of available prophylactic guidelines will these be reduced.