Lung problems and HIV

The role of the lungs is to absorb oxygen from the air and transfer it to the blood where it is then circulated around the body.

At the same time, waste products like carbon dioxide move in the opposite direction, travelling from the blood, through the lungs to be breathed out.

Lung problems are more common in people living with HIV than in the general population. Problems with your lungs can mean you find it hard to breathe or that you have unpleasant symptoms like wheezing or coughing.

How does HIV affect your lungs?

HIV seems to affect lung function. ‘Lung function’ is how well your lungs work to help you breathe.

As you age, your lung function declines, whether or not you have HIV. However, research shows that lung function declines faster in people if they are living with HIV. People who have had a low CD4 cell count in the past seem to have faster declines in lung function.

People with HIV also seem more likely to report breathing and lung problems such as breathlessness or a long-term cough.

As with anybody else, people with HIV can also contract colds or influenza (flu), which can affect the chest, causing symptoms such as a cough, and the production of phlegm. These normally clear up in a few days and usually cause no lasting damage.

Taking HIV treatment can prevent your immune system becoming so weak that you develop serious lung infections.

Smoking and HIV

Smoking affects lung function. For both people with and without HIV, smoking leads to a quicker decline in lung function when compared to people who don’t smoke.

People living with HIV are more likely to smoke. Some research suggests that this could explain why lung function is different in people living with HIV, but it isn’t known for sure.

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is the name used to describe a group of lung conditions which make it harder to breathe. It includes emphysema (damage inside the lungs) and chronic bronchitis (inflammation of the airways).

Although COPD usually affects people who smoke, having HIV is associated with a higher risk of COPD, whether or not you smoke. One study also found that smoking has a greater impact on COPD in people living with HIV than in HIV-negative people. People with HIV are also more likely to have worse symptoms of COPD.

The risk of developing COPD is higher if you have a high viral load or if you have, or have ever had, a very low CD4 count.

There are lots of treatments for COPD, and the treatment you’re offered will depend on your symptoms. They include:

• Smoking cessation – there are many things that can help increase your odds of being able to quit smoking, which is the most important thing you can do if you have COPD.
• Pulmonary rehabilitation – a type of physiotherapy that helps with breathlessness.
• Inhalers and nebulisers – devices that deliver medicine into your lungs which can help you to breathe or help you if you have a cough.
• Long-acting bronchodilators – a type of medicine that opens up your airways and help with breathlessness.
• Machines and devices that help you breathe, such as non-invasive ventilation or oxygen therapy.

You can check whether you are getting COPD treatment that is recommended in UK guidelines by using the patient passport provided by Asthma + Lung UK.

There are some interactions between some of the medicines used to treat COPD and HIV, so it’s important that the person prescribing your COPD treatment knows about your HIV treatment. As well as asking a doctor or pharmacist to check for potential interactions, there’s information on the University of Liverpool’s HIV Drug Interactions website.

Asthma

Asthma is one of the most common lung problems. It’s a condition that makes your airways inflamed and narrower, which makes it harder to breathe. If you have asthma, you might get breathless, wheeze, feel like your chest is tight, or have a cough. When these symptoms happen very suddenly, it’s called an asthma attack. 

It’s not clear if having HIV raises your risk of developing asthma, but there is some evidence that people with HIV might have more inflamed airways. Also, men with HIV report worse asthma symptoms than those who don’t have HIV.

If you have asthma, you might be given an inhaler containing a medicine called salbutamol to help you breathe during an asthma attack. There aren’t any known interactions between salbutamol and HIV medication. However, there are some interactions between some of the anti-inflammation medications included in other inhalers and some HIV medications. As well as asking a doctor or pharmacist to check for potential interactions, there’s information on the University of Liverpool’s HIV Drug Interactions website. 

Pneumonia

Pneumonia is an infection of the lungs that causes inflammation. The infecting organism may be bacteria, a virus (such as influenza), a fungus (such as Pneumocystis pneumonia or PCP) or something else.

Pneumonia can also cause pleurisy (inflammation of the membrane surrounding the lungs) which can cause chest pain when you breathe in.

Bacterial pneumonia can be more serious in people with HIV and occur with more frequency, particularly if they have a weakened immune system. Getting your flu vaccine each year can help prevent bacterial pneumonia from developing by stopping you from getting flu.

There are also vaccines to reduce your risk of bacterial pneumonia. The British HIV Association recommends that all people living with HIV should be vaccinated against pneumococcal disease (a cause of bacterial pneumonia). There is more information about pneumococcal disease on our page Pneumococcal disease and HIV.

Quitting smoking will also reduce your risk of pneumonia.

Pneumonia due to pneumocystis (PCP) also affects the lungs. However, it is normally seen only in people with a CD4 count below 200. It is rare in countries where people have access to modern medical care.

Antibiotics can be used to treat bacterial lung infections such as pneumonia and can also be successfully used to treat PCP. There are also antiviral medications for some viruses like influenza.

Tuberculosis (TB)

Tuberculosis (TB) is seen in increased rates amongst people with HIV. Globally, it is the leading causes of illness and death amongst people with HIV.

TB can develop at any time during HIV infection, but people with weakened immune systems are more vulnerable to infection.

TB can be treated and cured, but how this is done will depend on how the illness is affecting you. Most people with TB who have symptoms will take antibiotics for six months. People who aren’t having symptoms (called ‘latent TB’) might only need to take them for three months.

There is more information about TB on our page Tuberculosis and HIV.

Lung cancer

Lung cancer is more common in HIV-positive people than in the general HIV-negative population. It also seems to be diagnosed at a younger age in people living with HIV compared to the general population.

However, lung cancer is usually diagnosed and treated in the same way for everybody, regardless of their HIV status.

In 2022, the National Screening Committee in the UK recommended that people should be invited to screening if they’re at high risk for lung cancer. Since then, the NHS in England has started lung cancer screening for everyone aged between 55 and 74 who either smokes or used to smoke. There are plans to make screening programmes more widely available in the rest of the UK as well.

There is more information about HIV and lung cancer on our page HIV and lung cancer.

The cancers Kaposi’s sarcoma and non-Hodgkin’s lymphoma, which are more common in people with very low CD4 counts, can also affect the lungs.

What kind of tests are used to diagnose lung problems?

Symptoms such as coughing, shortness of breath, coughing up blood, phlegm or mucus, and chest pain can all be signs of a problem in the lungs.

If you have any kind of breathing problem, your doctor will listen to your chest with a stethoscope to assess how well your lungs are working.

Other common tests to check for infection or disorders include:

• chest X-rays
• an induced sputum test - a mist of salty water is inhaled in order to ‘induce’ you to cough up sputum (mucus) from the lungs
• a bronchoscopy - a small camera is passed down the nose and can collect fluid or biopsies from the lungs
• lung-function tests – these measure lung capacity and the ability to transfer oxygen
• a body scan - this may be used to look for some infections or cancers or other lung conditions.

How can I keep my lungs healthy?

If you smoke, the best thing you can do to improve your lung health is to stop smoking. There is more information about stopping smoking on our page Smoking and HIV.

Having a healthy lifestyle, including getting regular exercise, will also help your lung health.

Other sources of information

You may find Asthma + Lung UK helpful. Visit their website or call their helpline (from the UK) on 0300 222 5800.

You can check for interactions between your anti-HIV medication and other medications on the HIV Drug Interactions website.