Pulmonary complications are exceedingly common among patients infected with HIV. Moreover, the longer life expectancy of HIV-infected individuals has led to the recognition of many infectious and non-infectious pulmonary complications, including the well-established association between HIV and pulmonary hypertension (HIV-PH). In this center, we are the referral group for all HIV providers within Boston Medical Center for evaluation and treatment of the pulmonary and mycobacterial complications that occur in HIV-infected individuals.
Pulmonary complications of HIV infection increase as the disease progresses. Although the most common cause of pulmonary disease remains infectious, including tuberculous and non-tuberculous mycobacteria, a number of non-infectious entities occur in the HIV-infected individual with pulmonary symptoms.
Moreover, with the advent of highly active antiretroviral therapy (HAART) there have been significant changes in the epidemiology of these diseases. In those patients in whom thorough microbiologic survey reveals no infection, non-infectious entities should be considered. Among these non-infectious entities are malignancies (bronchogenic carcinoma, lymphoma, KS), inflammatory (LIP, sarcoid-like immune reconstitution syndrome) and pulmonary vascular disease (pulmonary hypertension).
We have developed a particular interest in pulmonary hypertension associated with HIV infection (PH-HIV). The longer life expectancy of HIV-infected patients has seemingly led to the well-established association between HIV and pulmonary hypertension. HIV-PH was first described in 1987 and although much of our present understanding of the disease comes from research in idiopathic pulmonary arterial hypertension (IPAH, formerly termed primary pulmonary hypertension,) there are clearly differences between the two entities. For example, there are differences in the incidence, rate of progression, and response to treatment of HIV-PH and IPAH despite their shared plexogenic vascular histology. We have focused mostly on development of treatment for HIV-PH and have been instrumental in describing the response of these patients to prostacyclins.
- HIV-related lung disease
- Evaluation and treatment of HIV-PH
- Registry and description of lung cancer in HIV patients (in collaboration with Boston Medical Center’s Oncology Section)
Basic Science Research:
see the webpage of the HIV/TB Pulmonary Research Group.
Evaluation of drug therapy for HIV-PH and the effect of PAH therapies, especially endothelin receptor antagonists, on the drug levels of antiretroviral medications. For further details, please refer to the webpage of the Pulmonary Hypertension Center for Translational-Clinical Research.
- Harrison W. Farber, MD
- Michael Ieong, MD
- Denise Brett-Curran, RN
- Ieong MH, Farber HW. Non-infectious pulmonary complications of HIV infection Clin Pulm Med 2006; 13:194-202.
- Wilson KC, Bielska B, Farber HW. Mycobacterium marinum osteomyelitis. Orthopedics 2003; 26:1-2.
- Farber HW. HIV-associated pulmonary hypertension. AIDS Clinical Care 2001; 13:53-59
- Wittram C, Fogg JF, Farber HW. Pulmonary sarcoidosis: A manifestation of the immune restoration syndrome. AJR. American Journal of Roentgenology 2001; 177:1427.
- Aquilar RV, Farber HW. Long-term epoprostenol (prostacyclin) therapy in HIV-associated pulmonary hypertension. Am J Resp Crit Care Med 2000; 162:1846-1850.
- Keaveny AP, Karasik MS, Farber HW. Successful treatment of chylous ascites secondary to Mycobacterium avium complex in a patient with the acquired immune deficiency syndrome. Am J Gastro 1999; 94:1689-1690.
- Montgomery AB, Feigal DW, Jr., Sattler F, Mason GR, Catanzaro A, Edison R, Markowitz N, Johnson E, Ogawa S, Rovzar M, Udem SA, Eden E, Hyslop N, Cheung TW, Kessler H, Mildvan D, Giron JA, Ettinger N, Crumpacker C, Frame, P, Steigbigel N, van der Horst C, Hirsch M, Lederman MM, Hewitt RG, Fallat R, Farber HW, Sacks HS, Eisman SA, Luce JM, Boylan T, Adams M, Feinberg J,Hopewell PC. Pentamidine aerosolized versus trimethoprim-sulfamethoxazole for pneumocystis carinii in Acquired Immunodeficiency Syndrome. Am J Respir Crit Care Med 1995; 151:1068-1074.
- Barber TW, Craven DE, Farber HW. Mycobacterium gordonae: An opportunistic respiratory tract pathogen in patients with advanced Human Immunodeficiency Virus, type 1 infection. Chest 1991; 100:716-720.
- Epoprostenol (Prostacyclin) Therapy in HIV-associated Pulmonary Hypertension
- Immune Restoration Syndrome Manifested by Pulmonary Sarcoidosis
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