Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1995 Nov;50(11):1141–1146. doi: 10.1136/thx.50.11.1141

Interstitial pneumonitis in patients infected with the human immunodeficiency virus.

M H Griffiths 1, R F Miller 1, S J Semple 1
PMCID: PMC475084  PMID: 8553268

Abstract

BACKGROUND--A study was performed to identify the clinical, radiographic, and histopathological features of interstitial pneumonitis in patients infected with the human immunodeficiency virus. METHODS--A retrospective review was made of the case notes, chest radiographs, and histopathological results of seven HIV-1 antibody positive patients with symptomatic diffuse pulmonary disease and a pathological diagnosis of non-specific interstitial pneumonitis. RESULTS--All patients had dyspnoea, with or without cough, and chest radiographs showing diffuse infiltrates. The arterial oxygen tension ranged widely from 5.9 to 13.1 kPa. The initial clinical diagnosis was Pneumocystis carinii pneumonia in most cases. The pathological diagnosis was made by transbronchial biopsy in one case and by open lung biopsy in six cases. The interstitial pneumonitis consisted of a patchy lymphocytic infiltrate composed of B cells in focal aggregates and T cells in a more diffuse distribution. The T cell population was a mixture of CD4+ and CD8+ cells. The histological findings contrast with the more extensive infiltrate of predominantly CD8+ lymphocytes seen in HIV-associated lymphocytic interstitial pneumonitis which occurs mainly in children. The condition ran a subacute course. Three patients spontaneously improved and three improved with steroid therapy. Long term survival was less than three years, the prognosis being determined by other infective or neoplastic complications. CONCLUSIONS--Non-specific interstitial pneumonitis usually presents with an illness resembling Pneumocystis carinii pneumonia but occurs when the CD4 and total lymphocyte counts are still preserved. The pneumonitis resolves spontaneously or responds to steroids, and does not itself lead directly to the patient's death. It does, however, appear to mark a downturn in the course of HIV infection.

Full text

PDF
1144

Images in this article

1143Image
on p.1143
1143Image
on p.1143

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andiman W. A., Eastman R., Martin K., Katz B. Z., Rubinstein A., Pitt J., Pahwa S., Miller G. Opportunistic lymphoproliferations associated with Epstein-Barr viral DNA in infants and children with AIDS. Lancet. 1985 Dec 21;2(8469-70):1390–1393. doi: 10.1016/s0140-6736(85)92557-7. [DOI] [PubMed] [Google Scholar]
  2. Autran B., Mayaud C. M., Raphael M., Plata F., Denis M., Bourguin A., Guillon J. M., Debre P., Akoun G. Evidence for a cytotoxic T-lymphocyte alveolitis in human immunodeficiency virus-infected patients. AIDS. 1988 Jun;2(3):179–183. [PubMed] [Google Scholar]
  3. Birley H. D., Buscombe J. R., Griffiths M. H., Semple S. J., Miller R. F. Granulomatous Pneumocystis carinii pneumonia in a patient with the acquired immunodeficiency syndrome. Thorax. 1990 Oct;45(10):769–771. doi: 10.1136/thx.45.10.769. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chayt K. J., Harper M. E., Marselle L. M., Lewin E. B., Rose R. M., Oleske J. M., Epstein L. G., Wong-Staal F., Gallo R. C. Detection of HTLV-III RNA in lungs of patients with AIDS and pulmonary involvement. JAMA. 1986 Nov 7;256(17):2356–2359. [PubMed] [Google Scholar]
  5. Church J. A., Isaacs H., Saxon A., Keens T. G., Richards W. Lymphoid interstitial pneumonitis and hypogammaglobulinemia in children. Am Rev Respir Dis. 1981 Oct;124(4):491–496. doi: 10.1164/arrd.1981.124.4.491. [DOI] [PubMed] [Google Scholar]
  6. Doskocil M., Med M., Vimmer T. Musculus rectus femoris--zacátecní slacha, její funkcní význam. Acta Chir Orthop Traumatol Cech. 1987 Apr;54(2):99–107. [PubMed] [Google Scholar]
  7. Ettensohn D. B., Mayer K. H., Kessimian N., Smith P. S. Lymphocytic bronchiolitis associated with HIV infection. Chest. 1988 Jan;93(1):201–202. doi: 10.1378/chest.93.1.201. [DOI] [PubMed] [Google Scholar]
  8. Foley N. M., Griffiths M. H., Miller R. F. Histologically atypical Pneumocystis carinii pneumonia. Thorax. 1993 Oct;48(10):996–1001. doi: 10.1136/thx.48.10.996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Grieco M. H., Chinoy-Acharya P. Lymphocytic interstitial pneumonia associated with the acquired immune deficiency syndrome. Am Rev Respir Dis. 1985 Jun;131(6):952–955. doi: 10.1164/arrd.1985.131.6.952. [DOI] [PubMed] [Google Scholar]
  10. Griffiths M. H., Kocjan G., Miller R. F., Godfrey-Faussett P. Diagnosis of pulmonary disease in human immunodeficiency virus infection: role of transbronchial biopsy and bronchoalveolar lavage. Thorax. 1989 Jul;44(7):554–558. doi: 10.1136/thx.44.7.554. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Guillon J. M., Autran B., Denis M., Fouret P., Plata F., Mayaud C. M., Akoun G. M. Human immunodeficiency virus-related lymphocytic alveolitis. Chest. 1988 Dec;94(6):1264–1270. doi: 10.1378/chest.94.6.1264. [DOI] [PubMed] [Google Scholar]
  12. Itescu S., Brancato L. J., Buxbaum J., Gregersen P. K., Rizk C. C., Croxson T. S., Solomon G. E., Winchester R. A diffuse infiltrative CD8 lymphocytosis syndrome in human immunodeficiency virus (HIV) infection: a host immune response associated with HLA-DR5. Ann Intern Med. 1990 Jan 1;112(1):3–10. doi: 10.7326/0003-4819-112-1-3. [DOI] [PubMed] [Google Scholar]
  13. Joshi V. V., Oleske J. M., Minnefor A. B., Saad S., Klein K. M., Singh R., Zabala M., Dadzie C., Simpser M., Rapkin R. H. Pathologic pulmonary findings in children with the acquired immunodeficiency syndrome: a study of ten cases. Hum Pathol. 1985 Mar;16(3):241–246. doi: 10.1016/s0046-8177(85)80009-5. [DOI] [PubMed] [Google Scholar]
  14. Joshi V. V., Oleske J. M. Pulmonary lesions in children with the acquired immunodeficiency syndrome: a reappraisal based on data in additional cases and follow-up study of previously reported cases. Hum Pathol. 1986 Jun;17(6):641–642. doi: 10.1016/s0046-8177(86)80143-5. [DOI] [PubMed] [Google Scholar]
  15. Lin R. Y., Gruber P. J., Saunders R., Perla E. N. Lymphocytic interstitial pneumonitis in adult HIV infection. N Y State J Med. 1988 May;88(5):273–276. [PubMed] [Google Scholar]
  16. Linnemann C. C., Jr, Baughman R. P., Frame P. T., Floyd R. Recovery of human immunodeficiency virus and detection of p24 antigen in bronchoalveolar lavage fluid from adult patients with AIDS. Chest. 1989 Jul;96(1):64–67. doi: 10.1378/chest.96.1.64. [DOI] [PubMed] [Google Scholar]
  17. Ognibene F. P., Masur H., Rogers P., Travis W. D., Suffredini A. F., Feuerstein I., Gill V. J., Baird B. F., Carrasquillo J. A., Parrillo J. E. Nonspecific interstitial pneumonitis without evidence of Pneumocystis carinii in asymptomatic patients infected with human immunodeficiency virus (HIV). Ann Intern Med. 1988 Dec 1;109(11):874–879. doi: 10.7326/0003-4819-109-11-874. [DOI] [PubMed] [Google Scholar]
  18. Oldham S. A., Castillo M., Jacobson F. L., Mones J. M., Saldana M. J. HIV-associated lymphocytic interstitial pneumonia: radiologic manifestations and pathologic correlation. Radiology. 1989 Jan;170(1 Pt 1):83–87. doi: 10.1148/radiology.170.1.2909125. [DOI] [PubMed] [Google Scholar]
  19. Plata F., Autran B., Martins L. P., Wain-Hobson S., Raphaël M., Mayaud C., Denis M., Guillon J. M., Debré P. AIDS virus-specific cytotoxic T lymphocytes in lung disorders. Nature. 1987 Jul 23;328(6128):348–351. doi: 10.1038/328348a0. [DOI] [PubMed] [Google Scholar]
  20. Reith P., Monnot E. A., Bathija P. J. Prolonged suppression of a corticotropin-producing bronchial carcinoid by oral bromocriptine. Arch Intern Med. 1987 May;147(5):989–991. [PubMed] [Google Scholar]
  21. Resnick L., Pitchenik A. E., Fisher E., Croney R. Detection of HTLV-III/LAV-specific IgG and antigen in bronchoalveolar lavage fluid from two patients with lymphocytic interstitial pneumonitis associated with AIDS-related complex. Am J Med. 1987 Mar;82(3):553–556. doi: 10.1016/0002-9343(87)90461-x. [DOI] [PubMed] [Google Scholar]
  22. Rubinstein A., Morecki R., Silverman B., Charytan M., Krieger B. Z., Andiman W., Ziprkowski M. N., Goldman H. Pulmonary disease in children with acquired immune deficiency syndrome and AIDS-related complex. J Pediatr. 1986 Apr;108(4):498–503. doi: 10.1016/s0022-3476(86)80822-8. [DOI] [PubMed] [Google Scholar]
  23. Semenzato G., Agostini C. Human retroviruses and lung involvement. Am Rev Respir Dis. 1989 Jun;139(6):1317–1322. doi: 10.1164/ajrccm/139.6.1317. [DOI] [PubMed] [Google Scholar]
  24. Solal-Celigny P., Couderc L. J., Herman D., Herve P., Schaffar-Deshayes L., Brun-Vezinet F., Tricot G., Clauvel J. P. Lymphoid interstitial pneumonitis in acquired immunodeficiency syndrome-related complex. Am Rev Respir Dis. 1985 Jun;131(6):956–960. doi: 10.1164/arrd.1985.131.6.956. [DOI] [PubMed] [Google Scholar]
  25. Solal-Celigny P., Couderc L. J., Herman D., Herve P., Schaffar-Deshayes L., Brun-Vezinet F., Tricot G., Clauvel J. P. Lymphoid interstitial pneumonitis in acquired immunodeficiency syndrome-related complex. Am Rev Respir Dis. 1985 Jun;131(6):956–960. doi: 10.1164/arrd.1985.131.6.956. [DOI] [PubMed] [Google Scholar]
  26. Suffredini A. F., Ognibene F. P., Lack E. E., Simmons J. T., Brenner M., Gill V. J., Lane H. C., Fauci A. S., Parrillo J. E., Masur H. Nonspecific interstitial pneumonitis: a common cause of pulmonary disease in the acquired immunodeficiency syndrome. Ann Intern Med. 1987 Jul;107(1):7–13. doi: 10.7326/0003-4819-107-1-7. [DOI] [PubMed] [Google Scholar]
  27. Travis W. D., Fox C. H., Devaney K. O., Weiss L. M., O'Leary T. J., Ognibene F. P., Suffredini A. F., Rosen M. J., Cohen M. B., Shelhamer J. Lymphoid pneumonitis in 50 adult patients infected with the human immunodeficiency virus: lymphocytic interstitial pneumonitis versus nonspecific interstitial pneumonitis. Hum Pathol. 1992 May;23(5):529–541. doi: 10.1016/0046-8177(92)90130-u. [DOI] [PubMed] [Google Scholar]
  28. Travis W. D., Lack E. E., Ognibene F. P., Suffredini A. F., Shelhamer J. Lung biopsy interpretation in the acquired immunodeficiency syndrome: experience of the National Institutes of Health with literature review. Prog AIDS Pathol. 1989;1:51–84. [PubMed] [Google Scholar]
  29. Yousem S. A., Colby T. V., Carrington C. B. Follicular bronchitis/bronchiolitis. Hum Pathol. 1985 Jul;16(7):700–706. doi: 10.1016/s0046-8177(85)80155-6. [DOI] [PubMed] [Google Scholar]
  30. Ziza J. M., Brun-Vezinet F., Venet A., Rouzioux C. H., Traversat J., Israel-Biet B., Barre-Sinoussi F., Chermann J. C., Godeau P. Lymphadenopathy-associated virus isolated from bronchoalveolar lavage fluid in AIDS-related complex with lymphoid interstitial pneumonitis. N Engl J Med. 1985 Jul 18;313(3):183–183. doi: 10.1056/NEJM198507183130313. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES