Pleural disease in patients with AIDS

Patients infected with HIV are at risk of developing a variety of infectious and malignant pleuropulmonary disorders. The three most common causes of AIDS-related pleural effusions are parapneumonic effusions or empyemas, tuberculosis, and Kaposi's sarcoma. However, the relative frequency of these conditions varies from series to series as well as from one region of the world to another. Pneumocystis carinii is a common pulmonary pathogen in AIDS, but it is rarely the cause of a pleural effusion. By contrast, P. carinii infection is strongly associated with the occurrence of spontaneous pneumothoraces. Pleural complications in AIDS are often difficult to treat and contribute significantly to the high morbidity and mortality of the syndrome. Recent progress in antiretroviral therapy as well as improved supportive care should lead to better survival rates in AIDS in the near future. Unfortunately, this progress may be associated with a growing number of patients with AIDS-related diseases, including the pleural complications discussed here.