[Respiratory manifestations of HIV infections in children]

Respiratory disorders during the course of infections in children who are HIV positive are frequent. These are interstitial pneumonia (IP) and bacterial pneumonia. The acute IP are most often infectious in particular opportunist infection, and are dominated by Pneumocystis carinii (PC, 82 to 86% of the infectious agents isolated). This is often a presenting feature of an HIV infection and the radiological picture is very variable and the diagnosis rests on bronchoalveolar lavage which is readily achievable even in the infant. The immediate outcome is usually favourable and cotrimoxazole is efficacious and well tolerated. However pneumonia to PC points to a poor prognosis because they are always associated with a profound deficit or cellular immunity. All these criteria are against the likelihood of lymphoid PI which is, however, much more frequent in children than in adults. It is the chronic interstitial pneumonia with a "large grain" miliary radiological pattern and preserved cellular immunity and the absence of opportunistic infections in particular PC pneumonia. In addition, beyond the absence of PC, the bronchoalveolar lavage liquid shows a constant hyperlymphocytosis without polymorphonuclear leucocytes which is significantly different from that which is observed during the course of PC pneumonia. The long term prognosis of chronic PI, however, remains guarded with the possibility of seeing a worsening of the immune function. As for bacterial pneumonias they usually present as an acute lobar pneumonia with a banal organism but severe gram negative pneumonias are possible justifying a detailed systematic approach in certain cases.