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Respiratory Symptoms in HIV-Infected Patients 

Respiratory symptoms in HIV-infected individuals increase in frequency as the CD4 cell count declines below 200 cells/FL. Cough occurs at a frequency of 27%, shortness of breath at 23%, and fever at 9%.


Spectrum of Respiratory Illnesses in HIV-Infected Patients

Bacterial Infections

Streptococcus pneumoniae
Haemophilus influenzae
Gram-negative bacilli (Pseudomonas aeruginosa,
Klebsiella pneumoniae)
Staphylococcus aureus

Mycobacterial Infections

Mycobacterium tuberculosis
Mycobacterium kansasii
Mycobacterium avium complex

Fungal Infections

Pneumocystis carinii
Cryptococcus neoformans
Histoplasma capsulatum
Coccidioides immitis
Candida species

Viral Infections

Herpes simplex virus

Parasitic Infections

Toxoplasma gondii
Strongyloides stercoralis


Kaposi's sarcoma

Non-Hodgkin's lymphoma

Bronchogenic carcinoma

Upper Respiratory Illnesses

Upper respiratory tract infection

Lower Respiratory Tract Disorders

Lymphocytic interstitial pneumonitis (LIP)
Nonspecific interstitial pneumonitis (NIP)
Acute bronchitis
Obstructive lung disease
Chronic bronchitis
Pulmonary vascular disease
Illicit drug-induced lung disease
Medication-induced lung disease
Primary pulmonary hypertension
Bronchiolitis obliterans organizing pneumonia (BOOP)


As the CD4 cell count declines below 500 cells/FL, episodes of bacterial pneumonia may be recurrent, and mycobacteria other than M. tuberculosis (e.g. M. kansasii).

At a CD4 cell count below 200 cells/FL, bacterial pneumonia is often accompanied by bacteremia and sepsis, and M. tuberculosis infection is often extrapulmonary or disseminated. Pneumocystis carinii pneumonia and pneumonia/pneumonitis due to Cryptococcus neoformans become significant considerations.

Below 100 cells/FL, bacterial pathogens, such as Staphylococcus aureus and Pseudomonas aeruginosa, and pulmonary involvement from Kaposi's sarcoma or Toxoplasma gondii are increasingly diagnosed.

At CD4 cell count <50 cells/FL, respiratory diseases caused by endemic fungi (Histoplasma capsulatum, Coccidioides immitis), Cytomegalovirus, M. avium complex, and nonendemic fungi (Aspergillus, Candida).

CD4 Cell Count Ranges for Selected HIV-Related
and Non-HIV-Related Respiratory Illnesses

Any CD4 cell count

Upper respiratory tract illness
Upper respiratory tract infection
Acute bronchitis
Obstructive airway disease
Bacterial pneumonia
Non-Hodgkin's lymphoma
Pulmonary embolus
Bronchogenic carcinoma

CD4 cell count <500 cells/FL

Bacterial pneumonia (recurrent)
Pulmonary mycobacterial pneumonia (nontuberculous)

CD4 cell count <200 cells/FL

Pneumocystis carinii pneumonia
Cryptococcus neoformans pneumonia
Bacterial pneumonia (associated with bacteremia/sepsis)
Disseminated or extrapulmonary tuberculosis

CD4 cell count <100 cells/FL

Pulmonary Kaposi's Sarcoma
Bacterial pneumonia (Gram-negative bacilli and Staphylococcus aureus increased)
Toxoplasma pneumonitis

CD4 cell count <50 cells/FL

Disseminated Histoplasma capsulatum
Disseminated Coccidioides immitis
Cytomegalovirus pneumonitis
Disseminated Mycobacterium avium complex
Disseminated mycobacterium (nontuberculous)
Aspergillus pneumonia
Candida pneumonia