Surgical treatment of thoracic empyema in HIV-infected patients: severity and treatment modality is associated with CD4 count status.
OBJECTIVE
Patients infected with HIV have an increased propensity for developing thoracic empyemas secondary to their susceptibility to polymicrobial pulmonary infections. We performed an assessment of the clinical outcomes of HIV patients undergoing surgical treatment of thoracic empyemas and reviewed the microbiology of these infections.


METHODS
We completed a retrospective analysis of the patients who had been referred for surgical treatment of thoracic empyemas over an 11-year period, ending in 2002. The patients were treated at a major metropolitan medical teaching facility that cares for a substantial number of HIV-positive patients.


RESULTS
Twenty-one HIV-infected patients underwent surgical treatment of thoracic empyemas. There were no immediate deaths. Sixty-two percent of the patients had CD4 counts of < 200 cells/microL. Eight patients had postoperative complications. Six of the patients with complications had CD4 counts of < 200 cells/microL. Patients with lower CD4 counts were at risk for mycobacterial and fungal infections. Additionally, they often had complex empyemas that were not favorable for treatment by video-assisted thoracic surgery. Therefore, these patients often required surgery with lung resection, which necessitated longer periods of postoperative chest tube drainage.


CONCLUSIONS
Surgeons can obtain satisfactory operative outcomes when treating thoracic empyemas in HIV patients; however, the treatment strategy should be individualized. Patients with CD4 counts of < 200 cells/microL more commonly have complex empyemas that require surgery with open decortication and drainage. Although these patients have a higher incidence of postoperative complications, we think that HIV patients with thoracic empyemas can be safely and effectively treated with surgical techniques.
Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-8879, USA. Michael.Dimaio@UTSouthwestern.edu
Shamsuddin
S
Khwaja
David H
DH
Rosenbaum
Michelle C
MC
Paul
Rehal A
RA
Bhojani
Aaron S
AS
Estrera
Michael A
MA
Wait
J Michael
JM
DiMaio
D017088:AIDS-Related Opportunistic Infections / Q000601:surgery*; D000328:Adult; D018791:CD4 Lymphocyte Count; D016724:Empyema, Pleural / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome