Lungs are the most commonly affected organs in HIV, being affected in 90 per cent of patients. Infections like upper RTI, sinusitis and pharyngitis occur 10 times more frequently in the HIV positive than in HIV negative patients, says Dr Zarir Udwadia, Mumbai.

Pneumocytis Carini Pneumonia (PCP) is declining in the West, but not so in India, mainly due to lack of diagnostic facilities. Most important lung manifestation of HIV in India is Tuberculosis. Over 15 million people are currently infected globally, of which a large number live in India. Tuberculosis marks a turning point in the HIV positive patient. Even if the patient recovers from TB, the HIV viral load increases and patients have increased mortality in comparison with TB patients with HIV negative. Sputum positivity is less in HIV positive patients, he added

Treating TB in HIV positive patients is difficult because of the complex interactions that occur between rifampicin and the protease inhibitors and non-nucleoside reverse transcriptase inhibitors. Ideally a specialist should treat these patients. Another problem is the frequent occurrence of ‘paradoxical reactions’ in these patients. This makes the management even more difficult.

Dr Udwadia was in Hyderabad recently to deliver a lecture on ‘HIV and Related Respiratory Disorders’ as part of APICON (Annual Conference of Association of Physicians of India) 2004.