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HIV-associated lung disease

Nature Reviews Disease Primers volume 9, Article number: 39 (2023) Cite this article

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Abstract

Lung disease encompasses acute, infectious processes and chronic, non-infectious processes such as chronic obstructive pulmonary disease, asthma and lung cancer. People living with HIV are at increased risk of both acute and chronic lung diseases. Although the use of effective antiretroviral therapy has diminished the burden of infectious lung disease, people living with HIV experience growing morbidity and mortality from chronic lung diseases. A key risk factor for HIV-associated lung disease is cigarette smoking, which is more prevalent in people living with HIV than in uninfected people. Other risk factors include older age, history of bacterial pneumonia, Pneumocystis pneumonia, pulmonary tuberculosis and immunosuppression. Mechanistic investigations support roles for aberrant innate and adaptive immunity, local and systemic inflammation, oxidative stress, altered lung and gut microbiota, and environmental exposures such as biomass fuel burning in the development of HIV-associated lung disease. Assessment, prevention and treatment strategies are largely extrapolated from data from HIV-uninfected people. Smoking cessation is essential. Data on the long-term consequences of HIV-associated lung disease are limited. Efforts to continue quantifying the effects of HIV infection on the lung, especially in low-income and middle-income countries, are essential to advance our knowledge and optimize respiratory care in people living with HIV.

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Fig. 1: Risk of HIV-associated lung diseases.
Fig. 2: Factors implicated in the pathogenesis of acute and chronic lung disease in people living with HIV.
Fig. 3: Effects of HIV on the structure and function of alveoli and the airway epithelium.
Fig. 4: Manifestations of HIV-associated lung disease.

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Authors and Affiliations

  1. Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Ioannis Konstantinidis & Alison Morris

  2. Veterans Affairs Puget Sound Healthcare System and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA

    Kristina Crothers

  3. Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA

    Ken M. Kunisaki

  4. Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    M. Bradley Drummond

  5. Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark

    Thomas Benfield

  6. Department of Paediatrics & Child Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

    Heather J. Zar

  7. SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa

    Heather J. Zar

  8. Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Laurence Huang

  9. Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Laurence Huang

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  1. Ioannis Konstantinidis
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  6. Heather J. Zar
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Contributions

Introduction (A.M.); Epidemiology (I.K.); Mechanisms/pathophysiology (A.M., K.C., M.B.D., T.B. & L.H.); Diagnosis, screening and prevention (K.C., K.M.K., M.B.D., T.B. & H.J.Z.); Management (K.C., K.M.K., M.B.D., T.B. & H.J.Z.); Quality of life (K.M.K.); Outlook (L.H.).

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Correspondence to Alison Morris.

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Competing interests

K.M.K. reports personal fees for Data and Safety Monitoring Board activities (Nuvaira, Organicell) and consulting (Allergan/AbbVie) outside the published work. T.B. reports grants (Novo Nordisk Foundation, Lundbeck Foundation, Simonsen Foundation, GSK, Pfizer, Gilead, Kai Hansen Foundation and Erik and Susanna Olesen’s Charitable Fund) and personal fees (GSK, Pfizer, Bavarian Nordic, Boehringer Ingelheim, Gilead, MSD, Pentabase ApS, Becton Dickinson, Janssen and Astra Zeneca) outside the published work. The other authors declare no competing interests.

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Nature Reviews Disease Primers thanks K. A. Norris, M. C. I. Lipman, and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Konstantinidis, I., Crothers, K., Kunisaki, K.M. et al. HIV-associated lung disease. Nat Rev Dis Primers 9, 39 (2023). https://doi.org/10.1038/s41572-023-00450-5

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