Mycobacterial and nonbacterial pulmonary complications in hospitalized patients with human immunodeficiency virus infection: a prospective, cohort study.

Bekele Afessa

doi:10.1186/1471-2466-1-1

Abstract

BackgroundA prospective observational study was done to describe nonbacterial pulmonary complications in hospitalized patients with human immunodeficiency virus (HIV) infection.MethodsThe study included 1,225 consecutive hospital admissions of 599 HIV-infected patients treated from April 1995 through March 1998. Data included demographics, risk factors for HIV infection, Acute Physiology and Chronic Health Evaluation (APACHE) II score, pulmonary complications, CD4+ lymphocyte count, hospital stay and case-fatality rate.ResultsPatient age (mean ± SD) was 38.2 ± 8.9 years, 62% were men, and 84% were African American. The median APACHE II score was 14, and median CD4+ lymphocyte count was 60/μL. Pulmonary complications were Pneumocystis carinii pneumonia (85) in 78 patients, Mycobacterium avium complex (51) in 38, Mycobacterium tuberculosis (40) in 35, Mycobacterium gordonae (11) in 11, Mycobacterium kansasii (10) in 9, Cytomegalovirus (10) in 10, Nocardia asteroides (3) in 3, fungus ball (2) in 2, respiratory syncytial virus (1), herpes simplex virus (1), Histoplasma capsulatum (1), lymphoma (3) in 3, bronchogenic carcinoma (2) in 2, and Kaposi sarcoma (1). The case-fatality rate of patients was 11% with Pneumocystis carinii pneumonia; 5%, Mycobacterium tuberculosis; 6%, Mycobacterium avium complex; and 7%, noninfectious pulmonary complications.ConclusionMost pulmonary complications in hospitalized patients with HIV are from Pneumocystis and mycobacterial infection.

Highlights

A prospective observational study was done to describe nonbacterial pulmonary complications in hospitalized patients with human immunodeficiency virus (HIV) infection
This study describes the nonbacterial pulmonary complications detected among 1,225 hospital admissions of 599 adult patients with HIV infection
With the advent of antiretroviral therapy and chemoprophylaxis against some of the opportunistic infections, the morbidity and mortality of patients with HIV infection have declined in the last decade

Summary

Introduction

A prospective observational study was done to describe nonbacterial pulmonary complications in hospitalized patients with human immunodeficiency virus (HIV) infection. Since the beginning of the acquired immunodeficiency syndrome (AIDS) epidemic, pulmonary complications have been major causes of morbidity and mortality in patients with human immunodeficiency virus (HIV) infection [1]. In addition to the common pulmonary diseases affecting immunocompetent individuals, HIV seropositive patients are prone to other infectious and noninfectious complications. The types of pulmonary complications that develop depend on the degree of immunosuppression, HIV transmission category, and geographic location. Knowledge of the types of pulmonary complications in patients with HIV infection will help clinicians to develop better diagnostic and therapeutic approaches. This article describes the nonbacterial pulmonary complications that were detected at hospital admission and during hospitalization of 599 patients

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