Respiratory Support Strategies in AIDS
The first cases of acquired immunodeficiency syndrome (AIDS) were reported by the Centers for Disease Control (CDC) in 1981 (1). Later on the causative virus was discovered and initially called the human T-lymphotrophic virus type Ill/lymphadenopathy-associated virus (HTLV III/LAV) by scientists at the Pasteur Institute (2) and the National Institutes of Health (3), respectively, and successively renamed human immunodeficiency virus (HIV). It quickly became evident that the disease was a worldwide problem and that persons outside the originally described risk groups (intravenous drug abusers and male homosexuals) could also be afflicted (4). AIDS consists of a profound immunosuppression, predominantly of cell-mediated immunity, that leads to a variety of opportunistic diseases, particularly certain infections and neoplasms. The main cause of the immune defect in AIDS is a quantitative and qualitative deficiency in the subset of thymus-derived (T) lymphocytes termed the T4 population. These cells are defined phenotypically by the presence of the CD4 surface molecule, which is the cellular receptor for HIV. Virtually any human cell that expresses CD4 receptors can be infected; among them the monocyte-macrophage lineage is of particular importance. Once the T4-lymphocyte count drops to 200 cells/µl or less, the chances of developing an opportunistic infection such as Pneumocystis carinii pneumonia are high, and this level of T4 cells is prognostic of a serious clinical complication.
KeywordsHuman Immunodeficiency Virus Continuous Positive Airway Pressure Acquire Immune Deficiency Syndrome Acquire Immunodeficiency Syndrome Pneumocystis Carinii Pneumonia
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