PLEURAL DISEASE IN PATIENTS WITH ACQUIRED-IMMUNE-DEFICIENCY-SYNDROME

Given the multiple impairments in host defense that occur during HIV i nfection, patients with AIDS are at risk for a variety of pleural infe ctions and neoplasms. Of infectious causes, bacterial parapneumonic ef fusions and empyemas and tuberculous pleurisy occur more frequently th an effusions caused by Pneumocystis carinii. In the setting of systemi c Kaposi's sarcoma, pleural involvement is common, although diagnosis is difficult and therapeutic options are limited. Pleural effusions ca used by non-Hodgkin's lymphoma often occur in the setting of pulmonary parenchymal disease. The recently described entity of primary effusio n lymphoma occurs in the absence of solid organ involvement. The devel opment of a spontaneous pneumothorax in an HIV-infected individual sho uld prompt a search for P. carinii infection. Although these pneumotho races often recur and are difficult to manage, recent series suggest t hat surgical approaches to bronchopleural fistulas are reasonable in s elected patients.