Asboe D, Fisher M, Nelson M R, Kaplan D K, al-Kattan K, Gazzard B G
Department of HIV/Genitourinary Medicine, Chelsea and Westminster Hospital, London, UK.
Genitourin Med. 1996 Aug;72(4):258-60. doi: 10.1136/sti.72.4.258.
Pneumothorax is a not uncommon complication of advanced HIV infection, and may prove difficult to manage in view of its recalcitrant and recurrent nature. In this group where immunosuppression and reduced life expectancy are a feature, standard protocols are often abandoned in favour of a more conservative approach. This is often unsuccessful.
Patients attending the Department of Genitourinary Medicine, Chelsea and Westminster Hospital who sustained pneumothorax between 1988 and 1992 were identified retrospectively and their notes reviewed.
Fifteen patients were identified of whom three had post-procedural pneumothoraces. In the remaining 12 patients, 10 had previously had Pneumocystic carinii pneumonia (PCP), whilst all 12 had some evidence to suggest current PCP (seven proven, five presumptive). In those six patients with a single, unilateral pneumothorax, four were managed successfully with intercostal drainage alone (one patient died early, one required pleurectomy). In those with recurrent pneumothoraces or pneumothoraces that did not respond to prolonged intercostal drainage, failure of medical treatment was judged to have occurred and surgery was performed. Overall, conservative management failed in 7/11 patients. Conversely surgery resulted in resolution in 7/7 with recurrence seen in one individual. Median survival was similar in the two groups.
Pneumothorax in patients with AIDS is associated with a high rate of intercurrent PCP; a low threshold for treating this infection presumptively is indicated. Intercostal drainage was successful in patients with a single, unilateral pneumothorax. However, in patients with recurrent or bilateral pneumothorax extended periods on intercostal drainage were uniformly unsuccessful. Early surgical referral should be considered in this group.
气胸是晚期人类免疫缺陷病毒（HIV）感染中并不罕见的并发症，鉴于其顽固和复发性，可能难以处理。在这个以免疫抑制和预期寿命缩短为特征的群体中，标准治疗方案常常被放弃，转而采用更保守的方法。但这往往并不成功。
对1988年至1992年间在切尔西和威斯敏斯特医院泌尿生殖医学科就诊且发生气胸的患者进行回顾性识别，并查阅他们的病历。
共识别出15例患者，其中3例为术后气胸。在其余12例患者中，10例曾患卡氏肺孢子虫肺炎（PCP），而所有12例均有一些证据提示目前患有PCP（7例确诊，5例推定）。在6例单侧单发气胸患者中，4例仅通过肋间引流成功治愈（1例患者早期死亡，1例需要胸膜切除术）。对于复发性气胸或对长时间肋间引流无反应的气胸患者，判定药物治疗失败并进行了手术。总体而言，11例患者中有7例保守治疗失败。相反，手术使7例患者中的7例病情得到缓解，仅1例复发。两组患者的中位生存期相似。
艾滋病患者的气胸与并发PCP的高发生率相关；提示应假定对此感染进行低阈值治疗。肋间引流对单侧单发气胸患者成功。然而，对于复发性或双侧气胸患者，长时间的肋间引流均未成功。对于该组患者应考虑早期手术转诊。
