Human immunodeficiency virus and respiratory infection.

Pulmonary disease remains a major problem for the 33 million individuals who are thought to be infected with human immunodeficiency virus (HIV) worldwide. Respiratory infections are responsible for a large number of the 2 million deaths that occur each year in association with HIV disease. In countries where the majority of the population can access highly active antiretroviral therapy, morbidity and mortality rates have been cut by up to 80%. This has allowed the withdrawal of specific opportunistic infection prophylaxis when immune restoration is deemed to be adequate. Recommendations have been published concerning Pneumocystis carinii prophylaxis. This year has also seen further reports of drug-resistant isolates of Pneumocystis carinii. The clinical relevance of this is still debated. Tuberculosis remains a global problem. The complexity of the interactions between specific anti-HIV and anti-tuberculous treatment have been highlighted. In the developing world, the importance of immunization and prophylaxis (against bacteria and mycobacteria) have recently been further defined in a number of studies.