AIDS and the lungs

Abstract

It is now well into the third decade of acquired immunodeficiency syndrome (AIDS) after the 1981 outbreaks of Pneumocystis carinii pneumonia (PCP) and Kaposi's sarcoma (KS) among previously healthy homosexual males in the United States. In 1983, the causative agent was discovered, which was subsequently called the human immunodeficiency virus (HIV). The World Health Organization estimated that 34.3 million people were infected by HIV by the year 2000, with 95% living in developing countries. About 90% of HIVseropositive patients were between 15 and 45 years old, with a male to female ratio of 5 to 1. The estimate for Southeast Asia numbered more than 5.8 million people(l ,2), with China accounting for over 500,000 people(3). In the late 1980s the organism was noted among intravenous drug users in Thailand, Myanmar and India. The seroprevalence in this group of patients dramatically increased from 1.2% in 1988 to 45% in 1991. The latest statistics showed that over 80% of all reported cases of HIV infection in Asia were in Thailand and in India, and the mode of disease transmission was primarily unprotected sexual intercourse with female prostitutes (4,5). The virus was seen in as many as 30-65% of female prostitutes in various cities in these countries. From 1984 to September 2002, there were 278,034 cases of AIDS and symptomatic HIV patients in Thailand, and 63,672 had died (6). The lung is the most frequently involved organ, and over 90% of the complications are caused by various infectious aetiologies. Table 1 shows a list of common respiratory disorders (7). Nowadays, with the use of highly active antiretroviral therapy (HAART), death and opportunistic infections have decreased by 60-90% while more non-infectious complications have surfaced (8,9). In Thailand as well as several other developing countries, there are governmental and private efforts to widen the practice of HAART by selling these medications at lower prices than previously charged. Even with this trend, there are very few studies in Asia addressing these noninfectious complications. © 2005 Hong Kong University Press, HKU. All righrts reserved.