Pneumothorax in HIV-infected patients
- Patricia A Tietjen, MD
Patricia A Tietjen, MD
- Professor of Clinical Medicine
- New York Medical College
- Section Editors
- John G Bartlett, MD
John G Bartlett, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — HIV; Pulmonary Infections
- Professor Emeritus
- Johns Hopkins University School of Medicine
- V Courtney Broaddus, MD
V Courtney Broaddus, MD
- Section Editor — Pleural Disease
- Professor of Medicine
- University of California San Francisco
Pneumothorax is an uncommon but potentially fatal complication of human immunodeficiency virus (HIV) infection [1-6]. Pneumothorax complicated 1.2 percent of all hospital admissions in a cohort of 599 HIV-infected patients followed over three years in a prospective observational study . In this report, development of a pneumothorax was associated with a significant increase in in-hospital mortality (31 versus 6 percent for patients without pneumothorax).
Causes of pneumothorax in HIV-infected individuals include Pneumocystis jirovecii pneumonia (PCP) [3,4,6-17], iatrogenic pneumothorax , Kaposi's sarcoma , intravenous drug abuse , toxoplasmosis , and bacterial, fungal, viral, and mycobacterial infections [1-4,21-23].
An overview of pneumothorax in HIV-infected patients will be presented here. Reviews of the etiology and treatment of primary and secondary spontaneous pneumothorax are presented separately. (See "Primary spontaneous pneumothorax in adults" and "Secondary spontaneous pneumothorax in adults".)
Although the cause of pneumothorax in patients with Pneumocystis jirovecii pneumonia (PCP) is unclear, the major hypotheses have focused on tissue necrosis produced by the organism and a possible role of prophylactic treatment with aerosolized pentamidine.
Pneumocystis jirovecii — Several investigators believe that extensive tissue invasion within the alveolar interstitium is common in severe PCP, and is an important factor in causing necrosis and subsequent pneumothorax [24-28]. The following observations illustrate this point:
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