Although persons with HIV are at increased risk for coagulopathies and pulmonary emboli⁹⁰ and may have cardiomyopathy, pericardial effusion, or clinical congestive heart failure,⁹¹ when patients complain of dyspnea it is most commonly an acute or subacute infectious process of the lung.^92,93 Tuberculosis is the most common pulmonary complication in this population; note, however, that TB presents with chronic rather than acute shortness of breath under these circumstances more often than not. Table 3.5 summarizes the differential diagnosis of infectious pulmonary syndromes.

In resource-poor settings, evaluation of shortness of breath may be limited to a detailed clinical examination, sputum examination, and basic chest radiograph; if available, computerized tomography (CT) scanning of the chest and echocardiography may be useful. The ability to specifically diagnose the pathogen causing an OI may be limited; thus, recognizing common clinical and radiographic patterns is critical for the prompt implementation of appropriate therapy. Infectious etiologies can be segregated by immunologic state and presentation.⁹⁴ Clinical evaluation and management of patients with shortness of breath is outlined in Protocol 3.19. Protocol 3.20 presents an evaluation algorithm for chest radiography.