Pneumothorax in AIDS

The acquired immunodeficiency syndrome (AIDS) is characterized by frequent infections, and the most common of which is pneumonia caused by Pneumocystis carinii. Some patients with P. carinii pneumonia develop a complication known as pneumothorax, in which air collects within the chest cavity, causing at least partial collapse of the lung. A study of AIDS patients with P. carinii pneumonia was performed to assess the frequency of pneumothorax and the predisposing factors to this condition. Of 1,030 AIDS patients with probable P. carinii pneumonia, 20 (2 percent) developed pneumothorax spontaneously. Patients who had experienced previous episodes of P. carinii pneumonia had a significantly increased risk of developing pneumothorax compared with patients experiencing their first bout of pneumonia. Additionally, those patients who were receiving an aerosolized form of pentamidine, an anti-Pneumocystis drug, were also found to have a greater risk for pneumothorax. Pneumothorax carries greater morbidity for AIDS patients than for others. Typically, the AIDS patients required chest tubes to correct the pneumothorax for 20 days, rather than the average three to four days. Chest tube therapy was adequate for only 4 of the 20; 5 needed surgical correction, and 11 underwent sclerotherapy, in which drugs are injected into the chest cavity to form scar tissue and seal the air leaks that caused the pneumothorax. Of the 20 patients who developed spontaneous pneumothorax, 19 had clear evidence of ongoing P. carinii pneumonia, despite the use of pentamidine by 18 of these patients. Interestingly, patients who developed pneumothorax tended to survive AIDS approximately 150 days longer than average AIDS patients, suggesting that their extended survival permitted them the opportunity to develop this complication. Based on these data, treating any AIDS patient who develops a spontaneous pneumothorax as if he had P. carinii pneumonia is prudent. (Consumer Summary produced by Reliance Medical Information, Inc.)