title: 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.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Florida Health Science Center, Jacksonville, FL, USA.
authors.forename: B
authors.initials: B
authors.lastname: Afessa
mesh_terms: 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