Clinical features and outcomes of HIV-related cytomegalovirus pneumonia.
OBJECTIVE
To describe the characteristics and outcomes of HIV-infected patients with biopsy-proven cytomegalovirus (CMV) pneumonia.


METHODS
Retrospective study.


METHODS
A 900-bed acute facility in New York City.


METHODS
Eighteen HIV-infected patients with pathologically confirmed CMV inclusions in lung tissue without other pathogens and 36 control patients with biopsy-proven Pneumocystis carinii pneumonia (PCP) selected for comparisons by computer-generated random sequential numbers.


METHODS
Demographic, clinical, laboratory, radiological findings, and in-hospital mortality.


RESULTS
Eighteen HIV-infected patients were found to have CMV lung infection alone. Pathologic findings were pneumonitis (n = 11); pneumonitis and pulmonary vasculitis (n = 1); and CMV inclusions alone (n = 6). All presented with respiratory symptoms (cough or dyspnea), 89% had fever, 83% had radiological abnormalities, and 56% had severe hypoxemia. The pulmonary presentation was similar except for higher lactate dehydrogenase (median, 449 versus 329 IU/l; P = 0.03) and presence of pleural effusions (33 versus 0%; P = 0.001) in CMV patients. Multivariate analysis showed that CD4 counts < or = 12 x 10(6)/l (odds ratio; 9.2; P = 0.029) and extrapulmonary CMV (odds ratio, 20.4; P = 0.039) were independently associated with CMV pneumonia. Seventeen patients received specific anti-CMV therapy for a mean of 22 +/- 13 days. In-hospital mortality was higher in patients with CMV pneumonia (odds ratio, 11.9; P = 0.002). The median time from admission to death was 31 days.


CONCLUSIONS
CMV lung infection was seen in severely immunosuppressed HIV-positive patients and associated with clinical pneumonitis with high early mortality. Although the clinical features resemble PCP, the presence of extrapulmonary CMV disease should suggest the diagnosis of CMV pneumonia.
Salomon
N
N
Department of Medicine, Beth Israel Medical Center, New York, New York 10003, USA.
Gomez
T
T
Perlman
D C
DC
Laya
L
L
Eber
C
C
Mildvan
D
D
D017088:AIDS-Related Opportunistic Infections / Q000473:pathology*; D000328:Adult; D018791:CD4 Lymphocyte Count; D003586:Cytomegalovirus Infections / Q000150:complications / Q000473:pathology*; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000473:pathology; D011024:Pneumonia, Viral / Q000150:complications / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies