PNEUMOTHORAX IN AIDS - CASE REVIEWS AND PROPOSED CLINICAL MANAGEMENT

Background: Pneumothorax is a not uncommon complication of advanced Hr infection, and may prove difficult to manage in view of its recalcitr ant and recurrent nature. In this group where immunosuppression and re duced life expectancy are a feature, standard protocols are often aban doned in favour of a more conservative approach. This is often unsucce ssful. Methods: Patients attending the Department of Genitourinary Med icine, Chelsea and Westminster Hospital who sustained pneumothorax bet ween 1988 and 1992 were identified retrospectively and their notes rev iewed. Results: Fifteen patients were identified of whom three had pos t-procedural pneumothoraces. In the remaining 12 patients, 10 had prev iously had Pneumocystic carinii pneumonia (PCP), whilst all 12 had som e evidence to suggest current PCP (seven proven, five presumptive). In those six patients with a single, unilateral pneumothorax, four were managed successfully with intercostal drainage alone (one patient died early, one required pleurectomy). In those with recurrent pneumothora ces or pneumothoraces that did not respond to prolonged intercostal dr ainage, failure of medical treatment was judged to have occurred and s urgery was performed. Overall, conservative management failed in 7/11 patients. Conversely surgery resulted in resolution in 7/7 with recurr ence seen in one individual. Median survival was similar in the two gr oups. Conclusions: Pneumothorax in patients with AIDS is associated wi th a high rate of intercurrent PCP; a low threshold for treating this infection presumptively is indicated. Intercostal drainage was success ful in patients with a single, unilateral pneumothorax. However, in pa tients with recurrent or bilateral pneumothorax extended periods on in tercostal drainage were uniformly unsuccessful. Early surgical referra l should be considered in this group.