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 Zambia HIV National Guidelines
 


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 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Diagnosis>Organ System>
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Lymphoid interstitial pneumonitis

Noah Lechtzin, M.D.
08-06-2008

  • LIP is common cause of chronic respiratory disease in HIV+ African children, but no studies published from Zambia.
  • Since LIP was not recognized clinical problem prior to the HIV epidemic, health workers may have little knowledge of the condition; often misdiagnosed as miliary or pulmonary TB.
  • Several reports (from S. Africa, Zimbabwe, Rwanda, Malawi) of HIV+ children with chronic respiratory symptoms found LIP to be the most common Dx.
  • Children with LIP usually present after 2 years of age; associated clinical features include generalized lymphadenopathy, bilateral nontender parotid enlargement, digital clubbing, and marked hepatomegaly.
  • Secondary bacterial infection/pneumonia due to S. pneumoniae or Salmonella is common.
  • Corticosteroids are useful in alleviating symptoms, but prophylaxis or even treatment for pulmonary TB should also be considered.

REFERENCES

Zambia Information Author: David Riedel, M.D.

PATHOGENS

CLINICAL

  • Diffuse idiopathic interstitial lung disease; key pathologic finding: polyclonal lymphoid cell infiltrate of alveolar septae
  • Occurs in <1% of HIV+ adults but up to 40% HIV+ children
  • Sx: gradual onset dyspnea, cough, and fever
  • May be asymptomatic, especially adults
  • Less common Sx: weight loss, pleuritic pain, arthralgia
  • PE: basilar crackles; children may have adenopathy & clubbing
  • Approximately 2/3 of cases are indolent but 1/3 progress more rapidly

DIAGNOSIS

  • CXR: bilateral, reticulonodular densities and or small nodules
  • High resolution CT: bilateral ground glass infiltrates and nodules (2-4 mm), occasionally cysts
  • In adults surgical lung biopsy usually necessary for diagnosis
  • Children may be diagnosed empirically if CXR abnormalities persist >2 mos and no evidence of infectious cause (usually by bronchoscopic exclusion).
  • Frequently mimics PCP and may be misdiagnosed clinically

TREATMENT

Initial Therapy

  • Children have been treated with prednisone 2 mg/kg once-daily x 2-4 wks followed by taper
  • Adults should receive 1 mg/kg once-daily of prednisone x 8-12 wks, followed by taper over 6-8 wks to 0.25mg/kg
Duration of Therapy

  • Data on treatment limited and optimal duration unknown, but 6-12 mos common
  • Some pts require life-long low-dose corticosteroids (e.g. prednisone 0.25 mg/kg once-daily)
Adjunctive Therapy

  • Case reports of children improving with antiviral therapy (acyclovir 1,500 mg/m2 daily) directed at EBV
  • May improve with institution of HAART

FOLLOW UP

  • Resolves with 6-12 mos of corticosteroid treatment in some, but others may require life-long low-dose corticosteroid therapy
  • Obtain serial thoracic CT and pulmonary function tests every 2-3 mos to assess initial response to treatment
  • Decrease frequency of follow up if disease improves or stabilizes

REFERENCES

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