Pleural fluid findings in patients with the acquired immunodeficiency syndrome: Correlation with concomitant pulmonary disease

Background. We sought to define the spectrum of conditions associated with pleural effusion (PE) in patients with the acquired immunodeficiency syndro me (AIDS) who submitted to diagnostic thoracentesis. Methods. The medical records of patients with human immunodeficiency virus (HIV) infection and PE studied by thoracentesis over a 5-year period, were reviewed for demographics, clinical presentation, concomitant illnesses, pl eural fluid analysis, management, and outcome. Results. Thoracentesis was done in 30 patients, 24 men and 6 women, with an overall mean age of 36 +/- 9 years. Mean CD4 cell count a as 157 +/- 249/m m(3). The cause of the PE was infectious in 21 (70%) and noninfectious in 9 (30%). Bacterial pneumonia was the most common cause of PE (57%). Streptoc occus pneumoniae and Staphylococcus aureus were the major organisms recover ed, Mycobacterial infections were present in 3 patients, and Nocardia sp wa s isolated from 1 patient. Non-Hodgkin's lymphoma (5 cases) was the leading noninfectious cause of PE, followed by Kaposi's sarcoma (3 cases) and aden ocarcinoma of the lung (1 case). Twelve of the 30 patients died during hosp italization. Conclusion. Pleural effusion is an important problem in patients with advan ced HIV infection. It is most frequently associated with bacterial pneumoni a. Cytologic and microbiologic examination of the pleural fluid is helpful in determining the cause of PE in this patient population.