Spontaneous pneumothorax in patients with the human immunodeficiency virus: study of eight cases

To evaluate the risk factors and the natural history of spontaneous pneumothorax in patients with human immunodeficiency virus infection (HIV).

We studied eight HIV infected patients with spontaneous pneumothorax. Variables assessed included sex, age, risk factor for HIV infection, use of Pneumocystis carinii pneumonia prophylaxis, total and CD4 positive lymphocyte count, previous history of Pneumocystis carinii pneumonia or pulmonary tuberculosis, chest X-ray film, presence of simultaneous opportunistic infection, partial pressure of oxygen in arterial blood gas determination and clinical outcome.

The patients were predominantly male and intravenous drug abusers. Mean age was 28 years (range: 21-44). Five patients had acquired immunodeficiency syndrome, 2 oral candidiasis and one asymptomatic HIV infection. Three had previously had Pneumocystis carinii pneumonia and six a concurrent opportunistic infection. No one was receiving aerosolized pentamidine prophylaxis. The pneumothorax was bilateral in two cases. Chest tube evacuation was required in seven, and six patients died. Only two patients without opportunistic infection were discharged.

We conclude that spontaneous pneumothorax is a serious problem with high mortality in patients with advanced human immunodeficiency virus infection. Previous or active Pneumocystis carinii pneumonia appear to be a risk factor for developing pneumothorax. It seems to be independent of aerosolized pentamidine use.