PLEURAL EFFUSIONS IN HOSPITALIZED-PATIENTS WITH AIDS

Objective: To determine the incidence, cause, and characteristics of pleural effusions in hospitalized patients with the acquired immunodeficiency syndrome (AIDS). Design: Retrospective. Participants: A total of 222 patients with AIDS hospitalized between January 1986 and January 1992 at the Medical University of South Carolina hospitals. Results: Pleural effusions occurred in 59 patients for an overall incidence of 27%. The mean age of the patients was 35 +/- 2 years (SE) and the male to female ratio was 5:1. The cause was infectious in 39 (66%) patients, noninfectious in 18 (31%), and unknown in 2 (3%). Pleural effusions were caused by bacterial pneumonia in 18 (31%) patients, Pneumocystis carinii pneumonia in 9 (15%), Mycobacterium tuberculosis in 5 (8%), septic embolism in 2 (3%), Nocardia asteroides in 2 (3%), cryptococcus neoformans in 2 (3%), and Mycobacterium arium intracellulare in 1 (2%). Among noninfectious causes (n = 18), hypoalbuminemia was the cause in 11 patients (19%), cardiac failure in 3 (5%), and atelectasis, Kaposi sarcoma, uremic pleurisy, and adult respiratory distress syndrome in 1 (2%) each. Patients with AIDS who had pleural effusions had significantly lower serum albumin levels and had lower CD4 counts than did those without pleural effusions (P < 0.001). Conclusions: Pleural effusions are common in hospitalized patients with AIDS. Bacterial pneumonia is the most common cause for pleural effusion in AIDS. Large effusions are associated with Kaposi sarcoma and tuberculosis. Hypoalbuminemia is a common cause of noninfectious pleural effusions.