Pulmonary infection in human immunodeficiency virus-infected patients in Taiwan

Background: Pulmonary infection is a major cause of morbidity and mortality in human immunodeficiency virus (HIV)-infected patients. Methods: We conducted a retrospective analysis of the pathogens causing pul monary infection in 272 HIV-infected patients admitted to a university hosp ital from January 1993 through December 1998. Results: A total of 158 (58%) patients had pulmonary complications, all but two of whom had acquired immunodeficiency syndrome (AIDS). There were 156 episodes of pulmonary infection, involving 124 patients. The most common pu lmonary infection was Pneumocystis carinii pneumonia (PCP): 66 patients had 77 episodes of PCP, all of which occurred in patients with CD4+ lymphocyte counts below 0.2 x 10(9)/L (200/mu L). Pulmonary tuberculosis (TB), diagno sed in 47 patients, was the second most common pulmonary infection. Twenty TB patients had open TB. HIV-infected patients who were immigrants from Sou theast Asia (9/23, 39%) had a higher risk of developing pulmonary TB than n onimmigrants (38/249, 15%) (p = 0.004). Only one of 17 episodes of communit y-acquired bacterial pneumonia was caused by Streptococcus pneumoniae. Less common opportunistic pulmonary pathogens included cytomegalovirus (5 cases ), Aspergillus species (3), Cryptococcus neoformans (3), Mycobacterium aviu m complex (2), Penicillium marneffei (1), Nocardia species (1), and Rhodoco ccus equi (1). Conclusions: PCP and pulmonary TB are the two leading pulmonary infections in Taiwanese HIV/AIDS patients. These findings should be taken into conside ration when developing management strategies and public health policies.