Advances in HIV-associated pulmonary diseases: an official American Thoracic Society workshop report

Abstract

People with HIV (PWH) are at increased risk of a broad range of infectious and non-infectious pulmonary diseases. Since the last ATS Workshop on HIV-associated pulmonary disease, large national and international cohorts have demonstrated ongoing gaps in our understanding of lung disease in this vulnerable population that range from underappreciation of disease incidence and prevalence to lack of targeted treatments. Translational work on the underlying mechanisms of disease has demonstrated novel, HIV-specific mechanisms that may lend themselves to tailored therapies. Twenty-four experts in HIV-associated lung disease from across the translational spectrum were invited to participate in this ATS-sponsored Workshop utilizing a modified Delphi method that included a series of pre- and post-workshop electronic surveys and a two-day virtual workshop. Lung disease among PWH is driven by complex and interrelated mechanisms including persistent immune dysregulation, oxidative stress, accelerated aging, and microbiome alterations. Despite these advances in our understanding, important gaps persist between mechanistic insights and clinical care that include limited HIV-specific trials, underrepresentation of PWH in studies of lung disease, and the absence of tailored care strategies. These gaps are further accentuated by substantial variation in the availability of data from the most affected populations, particularly in sub-Saharan Africa and among children and adolescents. Overcoming these challenges will require coordinated, globally representative research efforts that leverage large cohorts, integrate multi-omics and longitudinal phenotyping, use mechanistic insights to inform clinical trials, and consider implementation science approaches with the ultimate goal of developing tailored prevention and treatment strategies for HIV-associated pulmonary diseases.