Respiratory infections in patients with HIV infection.

Changes in epidemiology have influenced the spectrum of pulmonary diseases in HIV-infected populations. The increasing proportion of patients with AIDS who are intravenous drug users and members of racial or ethnic minorities correlate with increasing cases of bacterial pneumonia and tuberculosis. Both of these infections also occur more frequently with advanced immunosuppression. Antipneumocystis prophylaxis is also reducing the incidence and mortality rate from this infection, but when respiratory failure occurs with Pneumocystis carinii pneumonia, the mortality rate is high. Immunosuppression due to HIV causes active tuberculosis in many, and tuberculosis appears to accelerate the course of HIV disease. Directly observed therapy of tuberculosis has made a major impact on the incidence and cure rates of tuberculosis in areas of high prevalence. Pulmonary disease has been a major cause of illness and death in patients with HIV infection since the beginning of the AIDS epidemic. Early in the epidemic, P. carinii pneumonia was considered the predominant pulmonary disorder. However, epidemiologic shifts and advances in treatment have broadened our perspective on the diseases that patients with HIV infection develop.