Pleural effusion and pneumothorax in hospitalized patients with HIV infection: the Pulmonary Complications, ICU support, and Prognostic Factors of Hospitalized Patients with HIV (PIP) Study.
OBJECTIVE
To describe the incidence, causes, and impact of pleural effusion and pneumothorax in hospitalized patients with HIV infection.


METHODS
Prospective, observational.


METHODS
A university-affiliated medical center.


METHODS
During a 3-year period, 599 HIV-infected patients with a total of 1,225 consecutive hospital admissions were followed. A total of 1,097 hospital admissions were included. Patients' medical records, chest radiographs, and computerized laboratory values were reviewed.


RESULTS
Pleural effusions developed in 160 hospital admissions (14. 6%). The effusions were right sided (56%), left sided (29%), and bilateral (15%). Their sizes were small (65%), moderate (23%), large (9%), and massive (4%). The associated conditions were infectious: bacterial pneumonia (n = 50), pulmonary tuberculosis (n = 10), Pneumocystis carinii pneumonia (PCP; n = 5), and empyema (n = 2); and noninfectious: renal failure (n = 15), hypoalbuminemia (n = 12), malignancy (n = 9), pancreatitis (n = 7), hepatic cirrhosis (n = 5), congestive heart failure (n = 4), atelectasis (n = 3), pulmonary embolism (n = 3), trauma (n = 1), and surgery (n = 1). Pneumothorax developed in 13 hospital admissions (1.2%). The conditions associated with pneumothorax were iatrogenic (n = 4), bacterial pneumonia (n = 3), PCP (n = 2), positive pressure ventilation for PCP (n = 2), pulmonary Mycobacterium avium complex (n = 1), and trauma (n = 1). The in-hospital mortality of hospital admissions with pleural effusion was 10.0% compared to 5.4% of those without pleural effusion (p = 0.0407). The in-hospital mortality of hospital admissions with pneumothorax was 30.8% compared to 5.8% of those without pneumothorax (p = 0.0060).


CONCLUSIONS
Pleural effusions occur in 14.6% of hospital admissions in our patient population with HIV infection. Bacterial pneumonia is the condition most commonly associated with pleural effusion. Pneumothorax, seen in 1.2% of hospital admissions with HIV infection, is associated with poor outcome.
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Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Florida Health Science Center, Jacksonville, FL, USA.
D000046:Academic Medical Centers; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D010996:Pleural Effusion / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011030:Pneumothorax / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012124:Respiratory Care Units / Q000379:methods* / Q000706:statistics & numerical data