Non-tuberculosis opportunistic infections and other lung diseases in HIV-infected infants and children [State of the Art]

The diagnosis and management of human immunodeficiency virus (HIV) infected infants and children who do not respond to recommended empiric therapy for acute or chronic pneumonia is a frequent clinical challenge, especially as the greatest burden of childhood HIV-related lung disease occurs in low-income regions where options for investigation and treatment are limited. Lung disease is due to a wider spectrum of causes in HIV-infected than non-infected children. Bacterial pneumonia, viral pneumonia and pulmonary tuberculosis (TB) are common in children throughout the developing world, and the added impact of HIV infection on the incidence and outcome of these diseases is covered in companion articles. This review focuses on lung diseases that are more specifically HIV-related. Pneumocystis jirovecii pneumonia (PJP) is a major cause of pneumonia and death in HIV-infected infants, especially in regions where maternal HIV status is often not known and the provision of PJP prophylaxis for HIV-exposed infants is unusual. Cytomegalovirus is commonly found in the lungs of HIV-infected infants, with implications for the use of corticosteroids for PJP. Lymphoid interstitial pneumonitis, a common cause of persistent respiratory symptoms in HIV-infected children, must be differentiated from pulmonary or miliary TB. The incidence of uncommon causes such as fungal pneumonia or HIV-related pulmonary malignancy varies among regions. The burden of lung disease due to opportunistic infections would be significantly reduced by more widely applying available measures that reduce mother-to-child HIV transmission, by providing cotrimoxazole prophylaxis for HIV-exposed infants, and by increasing the availability of antiretroviral therapy.