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Pleural effusions in HIV-infected patients

Jose Joseph-Vempilly, MD
Section Editors
John G Bartlett, MD
V Courtney Broaddus, MD
Deputy Editor
Geraldine Finlay, MD


Pleural effusions are frequently encountered in patients with acquired immunodeficiency syndrome (AIDS). The prevalence of pleural effusion in hospitalized patients with AIDS varies from 7 to 27 percent [1-3]. The variations in prevalence may be explained by differences in the clinical stage of AIDS and the techniques used in detecting pleural effusion.

The majority of pleural effusions in patients with HIV infection are caused by infections; however, about a third are due to noninfectious causes [2]. Now that viral infections appear responsible for some of the malignant effusions (eg, Kaposi sarcoma, multicentric Castleman's disease, primary effusion lymphoma), the line between infectious and noninfectious causes is blurred. In addition, much of the data regarding prevalence come from hospitalized patients with advanced HIV infection in the pre-potent antiretroviral therapy (ART) era and may not reflect the post-potent ART experience.

The etiology of the pleural effusion can be established in the majority of patients with AIDS, although a small percentage remains undiagnosed, as is the case in the non-AIDS population [2]. (See "Diagnostic evaluation of pleural effusion in adults: Additional tests for undetermined etiology".)

The common causes of pleural effusions in patients with HIV infection are reviewed here. The general approach to the investigation of a pleural effusion is discussed separately. (See "Diagnostic evaluation of a pleural effusion in adults: Initial testing" and "Diagnostic thoracentesis".)


In patients with HIV infection, many of the same infectious agents that cause pneumonia should be considered as potential etiologies of pleural effusion (table 1A-B). Among studies of hospitalized patients with a pleural effusion and HIV infection, an infectious etiology was identified in about two-thirds [1-3]. In general, opportunistic infections of the pleura should be considered in patients with a CD4 count below 150 cells per microL, as these patients have an increased risk of opportunistic infection, possibly approaching that of pre-potent antiretroviral therapy (ART) patients.

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Literature review current through: Nov 2017. | This topic last updated: Feb 21, 2017.
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