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BACKGROUND: HIV-patients who develops spontaneous pneumothorax (PNX) frequently have Pneumocystis carinii infection (PCI). Treatment of PNX in HIV-patient is difficult (visceral pleura is necrotic so bronchopleural fistulas tend to persist).
METHODS: A retrospective review was completed from January 2001 to December 2004. 14 episodes of recurrent PNX in HIV-patients were treated. None of patients had chest trauma. VATS bullectomy with pleurodesis was performed. Patients were matched with non HIV-infected patients treated for recurrent PNX. Differences in means were tested for normal distribution, and compared using Student's t-test. Differences in group proportions were assessed using Fisher's exact test.
RESULTS: All patients were successfully managed with VATS approach. In 5 patients hemosiderin was evident in the resected specimen, consistent with recent rupture and hemorrhage. In 7 patients, diagnosis of PCI was made by identification of cysts with immunofluorescence assay. There were no air-leaks postoperatively, and no wound infections. Mean hospital stay was 4.4 ± 0.5 days. Follow-up ranged from 1 to 48 months (median: 21 months). No patients were lost to follow-up. Mortality procedure-related was absent. Two patients developed third episode of PNX (5 and 9 months after VATS) with recurrence rate of 14.29%. No difference was found between HIV and non HIV-infected populations in hospitalization time, overall mortality, and complications. PNX recurrence rates are higher in HIV-infected group.
CONCLUSIONS: This retrospective survey confirms that pneumothorax is not infrequently observed in HIV-infected patients. Treatment of PNX with VATS bullectomy and pleurodesis is a safe operative procedure with low mortality and complications.