Introduction

Despite advances in the treatment of HIV disease and the implementation of highly active antiretroviral therapy (HAART) as the standard of care in resource-rich countries [1], pulmonary diseases continue to cause significant morbidity and mortality in HIV-infected pediatric patients [2, 3]. With the advent of HAART, the incidence of opportunistic infections has declined, although some evidence suggests children may be developing AIDS-defining conditions at higher CD4+ T cell counts than previously [4]. Longitudinal studies have demonstrated that infection remains the most prevalent cause of death for children under 6 years of age, with 32% of deaths caused by pulmonary infection [5]. However, with increasing age, the frequency of HIV-associated pulmonary disease decreases significantly as the underlying cause of death. Common pulmonary diseases seen in pediatric HIV patients include: (1) lymphoproliferative processes that accompany HIV infection, such as lymphoid interstitial pneumonitis (LIP) or pulmonary lymphoid hyperplasia (PLH); (2) conventional infectious processes that may be exacerbated by the immunodeficiency caused by HIV infection; (3) opportunistic infections due to viral, bacterial, and fungal pathogens; and (4) disorders such as asthma/reactive airway disease, that may be associated with pulmonary infection or result from allergies or hypersensitivities which can be worsened by the immune dysregulation accompanying HIV infection.

Pneumocystis carinii pneumonia (PCP) remains the most common pulmonary complication of pediatric HIV infection in the USA [6, 7].