Clinical significance of resolution of chest X-ray findings in HIV-infected children with lymphocytic interstitial pneumonitis (LIP).

Lymphocytic interstitial pneumonitis (LIP) in HIV-infected children is generally associated with better prognosis as compared with children with Pneumocystis carinii pneumonia (PCP). We prospectively studied 12 cases of HIV-infected children with LIP over a 4-year period in an effort to document one aspect of the natural history of this clinical entity. Severe CD4 lymphocytopenia was associated with complete resolution of the chest X-ray findings in five patients, one of whom died of disseminated Mycobacterium avium complex. A second patient developed rapid-onset subacute HIV encephalopathy at the time when the CD4-lymphocyte count declined from 589 to 39, and the lung findings resolved spontaneously. The resolution of the lung pathology may be the first indication of severe immune suppression and a warning of the increased risk for opportunistic infections. Therefore, in those settings where diagnostic laboratory facilities are not easily available, the resolution of the reticulonodular changes on chest radiographs is a poor prognostic sign in HIV-infected children with LIP.