[Acquired immunodeficiency syndrome and the lung].

I n 1981, the Centers for Disease Control reported five cases of Pneumocystis carinii pneumonia in five previously healthy male homosexuals. Prior to this report, Pneumocystis carinii pneumonia occurred mainly in severely immunosuppressed patients who were receiving chemotherapy for cancer or organ transplants. Subsequently, numerous additional reports began to emerge describing opportunistic pneumonias and infections in male homosexuals, intravenous drug users, hemophiliacs and in Haitians; many of these patients also manifested an unusual and aggressive form of Kaposi’s sarcoma. Thus, what first appeared to be a medical curiosity has loomed as one of the most pernicious epidemics of our century. It is a disease that appears to be uniformly fatal and is predicted to afflict as many as 270,000 individuals in the USA by 1991.’ From the outset it was recognized that the cause of these unusual opportunistic infections was related to a severe and progressive derangement of the systemic immune system, leading to its designation as an acquired immune deficiency syndrome (AIDS). Despite its dominant manifestations in the lung, most studies of AIDS have been aimed at elucidating the immune abnormalities at the systemic level; relatively little information has been gathered on the effects of this disease on the host defenses of the lung. The purpose of this review will be first to identify what is currently known about the impact of this virus and disease on the immune apparatus of the lung, and then to discuss the pulmonary manifestations and management in the patient with AIDS. For interested readers, there have been several excellent general reviews dealing with the epidemiology, clinical features and systemic aspects of immunopathogenesis. 25