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Chronic HIV-associated lung disease including bronchiectasis
History of cough productive of copious amounts of purulent sputum (bronchiectasis only), with or without clubbing, halitosis, and crepitations and/or wheezes on auscultation. CXR; may show honeycomb appearance (small cysts) and/or persistent areas of opacification and/or widespread lung destruction, with fibrosis and loss of volume.

The chest radiograph of this 11-year-old, HIV-infected child shows increase pulmonary markings, bronchial wall thickening with dilatation, honey combing and cystic spaces. He had intermittent cough and sputum production. Crackles were frequently heard on physical examination. The managements include pulmonary toilet, hydration, and use of appropriate antibiotics.

 

Another 12-year-old HIV-infected boy with bronchiectasis presented with repeated "pneumonia" . His chest X-ray had never been clear.

Pulmonary complications including lymphocytic interstitial pneumonitis (LIP), Pneumocystis pneumonia, pulmonary tuberculosis, recurrent bronchitis and recurrent pneumonia are known to be common in HIV infected children in the first decade of life. These conditions could progress to bronchiectasis in the second decade of life.

The incidence of bronchiectasis was 16% in an American HIV-infected children cohort [ref 1]. Persistent lung disease is almost 3 times more common in HIV-infected than in uninfected African children [ref 2].

Ref 1. Sheikh S, Madiraju K, Steiner P, Rao M. Bronchiectasis in pediatric AIDS. Chest 1997;112:1202-07.
Ref 2. Jeena PM, Coovadia HM, Thula SA, Blythe D, Buckels NJ, Chetty R. Persistent and chronic lung disease in HIV-1 infected and uninfected African children. AIDS 1998 ;12:1185-93.

The figure shows clubbed fingers, due to chronic hypoxia in these children..
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