Pneumocystis-associated organizing pneumonia as a manifestation of immune reconstitution inflammatory syndrome in an HIV-infected individual with a normal CD4+ T-cell count following antiretroviral therapy.

We describe a rare case of Pneumocystic jirovecii-associated organizing pneumonia (PJP) in an HIV-infected individual on highly active antiretroviral therapy (HAART) with a CD4(+) T-cell count of 835 x 10(3) cells/mL and a low viral load. PJP was confirmed using transbronchial biopsies and bronchoalveolar lavage. The presentation in this patient suggests immune reconstitution inflammatory syndrome (IRIS) after institution of antiretroviral therapy (ART). This case report, however, is the first documented presentation of PJP in a patient with CD4 count greater than 300 prior to the induction of HAART who developed PJP and organizing pneumonia as a manifestation of IRIS. This suggests that there is continuing immune dysfunction in the face of re-expansion of CD4(+) T-cells and low viral load in HIV patients despite ART.

[Characteristics of human immunodeficiency virus infection in the San Juan de Dios General Hospital]. / Caracterizacion de la infeccion por el virus de inmunodeficiencia humana, en el Hospital General San Juan de Dios.

PIP: A prospective clinical study was conducted between January 1991 and June 1992 of 92 HIV seropositive patients attending the Adult Outpatient Clinic of the San Juan de Dios General Hospital in Guatemala City. 52 of the patients met the US Centers for Disease Control clinical criteria for AIDS. Limitations in the diagnostic and laboratory facilities of the hospital hampered identification of some opportunistic infections. 74 of the 92 patients were male. 3 of the 18 infected women gave birth during the study period; the status of their children is not yet known. 87% of the cases were in adults aged 18-40. 25 of the patients died during the 18-month study period and 9 were lost to follow-up. 57 of the 92 had lived in the US or Mexico. 43 of the 74 men reported homosexual relations. 6 reported use of intravenous drugs. 3 had received blood transfusions as the only known risk factor. 56 had histories of sexually transmitted diseases. 3 patients reported always using condoms, 57 never did so, and the rest did so occasionally. 52 of the patients had opportunistic infections. 18 had proven and 5 had presumptive extrapulmonary mycobacteria, probably tuberculosis. 2 had salmonella in the blood. 4 had presumptive cytomegalovirus, 6 had chronic mucocutaneous herpes, and 3 had presumptive HIV encephalopathy. 12 had esophageal candidiasis, 6 had extrapulmonary cryptococcosis, and 14 had pneumocystis carinii pneumonia. 13 had proven intestinal cryptosporidiosis, and 1 each had presumptive cerebral toxoplasmosis and extraintestinal strongyloidiasis. 3 had proven Kaposi's sarcoma and 1 had proven immunoblastic lymphoma. 10 had HIV-related weight loss.^ieng