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Processing of Bronchoalveolar Lavage Fluid and Matched Blood for Alveolar Macrophage and CD4+ T-cell Immunophenotyping and HIV Reservoir Assessment

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Interstitial lung disease in HIV.

Sarah R Doffman1, Robert F Miller

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Lymphocytic interstitial pneumonitis decreased in HIV patients after combination antiretroviral therapy (ART). Sarcoidosis, however, has become more common in HIV-infected individuals since ART introduction, possibly due to immune reconstitution.

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Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Immunology

Background:

  • Noninfectious lymphocytic infiltrative disorders were common in HIV-infected adults before combination antiretroviral therapy (ART).
  • These conditions, such as nonspecific interstitial pneumonitis and lymphocytic interstitial pneumonitis, are less frequent post-ART.
  • Sarcoidosis in HIV-infected individuals was rare before ART but is now increasingly recognized.

Purpose of the Study:

  • To investigate the changing landscape of interstitial pneumonitis in human immunodeficiency virus (HIV)-infected individuals.
  • To explore the potential impact of combination antiretroviral therapy (ART) on the incidence of these pulmonary conditions.
  • To examine the relationship between ART, immune reconstitution, and the emergence of sarcoidosis in HIV patients.

Main Methods:

  • Literature review and analysis of clinical observations.
  • Comparison of pulmonary disorder prevalence in the pre-ART and post-ART eras.
  • Exploration of immunological mechanisms potentially influenced by ART.

Main Results:

  • A significant decrease in nonspecific interstitial pneumonitis and lymphocytic interstitial pneumonitis was observed in HIV-infected adults following the introduction of ART.
  • An increase in the recognition of sarcoidosis among HIV-infected persons has been noted since the advent of ART.
  • Other causes of interstitial pneumonitis remain infrequent in the HIV-infected population.

Conclusions:

  • Combination antiretroviral therapy (ART) has altered the spectrum of pulmonary lymphocytic infiltrative disorders in HIV-infected individuals.
  • The rise in sarcoidosis post-ART may be linked to immune reconstitution phenomena in HIV patients.
  • ART has a significant impact on pulmonary immunology and disease presentation in HIV infection.