Skip to main content
Thorax logoLink to Thorax
. 2003 Aug;58(8):721–725. doi: 10.1136/thorax.58.8.721

The pulmonary physician in critical care • Illustrative case 5: HIV associated pneumonia

R Boyton 1, D Mitchell 1, O Kon 1
PMCID: PMC1746787  PMID: 12885994

Full Text

The Full Text of this article is available as a PDF (119.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Afessa B., Green B. Bacterial pneumonia in hospitalized patients with HIV infection: the Pulmonary Complications, ICU Support, and Prognostic Factors of Hospitalized Patients with HIV (PIP) Study. Chest. 2000 Apr;117(4):1017–1022. doi: 10.1378/chest.117.4.1017. [DOI] [PubMed] [Google Scholar]
  2. Afessa B., Green B. Clinical course, prognostic factors, and outcome prediction for HIV patients in the ICU. The PIP (Pulmonary complications, ICU support, and prognostic factors in hospitalized patients with HIV) study. Chest. 2000 Jul;118(1):138–145. doi: 10.1378/chest.118.1.138. [DOI] [PubMed] [Google Scholar]
  3. Alves C., Nicolás J. M., Miró J. M., Torres A., Agustì C., Gonzalez J., Raño A., Benito N., Moreno A., Garcìa F. Reappraisal of the aetiology and prognostic factors of severe acute respiratory failure in HIV patients. Eur Respir J. 2001 Jan;17(1):87–93. doi: 10.1183/09031936.01.17100870. [DOI] [PubMed] [Google Scholar]
  4. Arozullah A. M., Yarnold P. R., Weinstein R. A., Nwadiaro N., McIlraith T. B., Chmiel J. S., Sipler A. M., Chan C., Goetz M. B., Schwartz D. N. A new preadmission staging system for predicting inpatient mortality from HIV-associated Pneumocystis carinii pneumonia in the early highly active antiretroviral therapy (HAART) era. Am J Respir Crit Care Med. 2000 Apr;161(4 Pt 1):1081–1086. doi: 10.1164/ajrccm.161.4.9906072. [DOI] [PubMed] [Google Scholar]
  5. Benfield T. L., Helweg-Larsen J., Bang D., Junge J., Lundgren J. D. Prognostic markers of short-term mortality in AIDS-associated Pneumocystis carinii pneumonia. Chest. 2001 Mar;119(3):844–851. doi: 10.1378/chest.119.3.844. [DOI] [PubMed] [Google Scholar]
  6. Bowen E. F., Rice P. S., Cooke N. T., Whitfield R. J., Rayner C. F. HIV seroprevalence by anonymous testing in patients with Mycobacterium tuberculosis and in tuberculosis contacts. Lancet. 2000 Oct 28;356(9240):1488–1489. doi: 10.1016/S0140-6736(00)02876-2. [DOI] [PubMed] [Google Scholar]
  7. Bédos J. P., Dumoulin J. L., Gachot B., Veber B., Wolff M., Régnier B., Chevret S. Pneumocystis carinii pneumonia requiring intensive care management: survival and prognostic study in 110 patients with human immunodeficiency virus. Crit Care Med. 1999 Jun;27(6):1109–1115. doi: 10.1097/00003246-199906000-00030. [DOI] [PubMed] [Google Scholar]
  8. Casalino E., Mendoza-Sassi G., Wolff M., Bédos J. P., Gaudebout C., Regnier B., Vachon F. Predictors of short- and long-term survival in HIV-infected patients admitted to the ICU. Chest. 1998 Feb;113(2):421–429. doi: 10.1378/chest.113.2.421. [DOI] [PubMed] [Google Scholar]
  9. Curtis J. R., Bennett C. L., Horner R. D., Rubenfeld G. D., DeHovitz J. A., Weinstein R. A. Variations in intensive care unit utilization for patients with human immunodeficiency virus-related Pneumocystis carinii pneumonia: importance of hospital characteristics and geographic location. Crit Care Med. 1998 Apr;26(4):668–675. doi: 10.1097/00003246-199804000-00013. [DOI] [PubMed] [Google Scholar]
  10. Curtis J. R. ICU outcomes for patients with HIV infection: a moving target. Chest. 1998 Feb;113(2):269–270. doi: 10.1378/chest.113.2.269. [DOI] [PubMed] [Google Scholar]
  11. Curtis J. R., Yarnold P. R., Schwartz D. N., Weinstein R. A., Bennett C. L. Improvements in outcomes of acute respiratory failure for patients with human immunodeficiency virus-related Pneumocystis carinii pneumonia. Am J Respir Crit Care Med. 2000 Aug;162(2 Pt 1):393–398. doi: 10.1164/ajrccm.162.2.9909014. [DOI] [PubMed] [Google Scholar]
  12. De Palo V. A., Millstein B. H., Mayo P. H., Salzman S. H., Rosen M. J. Outcome of intensive care in patients with HIV infection. Chest. 1995 Feb;107(2):506–510. doi: 10.1378/chest.107.2.506. [DOI] [PubMed] [Google Scholar]
  13. Dworkin M. S., Hanson D. L., Navin T. R. Survival of patients with AIDS, after diagnosis of Pneumocystis carinii pneumonia, in the United States. J Infect Dis. 2001 Apr 10;183(9):1409–1412. doi: 10.1086/319866. [DOI] [PubMed] [Google Scholar]
  14. Efferen L. S., Nadarajah D., Palat D. S. Survival following mechanical ventilation for Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome: a different perspective. Am J Med. 1989 Oct;87(4):401–404. doi: 10.1016/s0002-9343(89)80821-6. [DOI] [PubMed] [Google Scholar]
  15. Friedman Y., Franklin C., Rackow E. C., Weil M. H. Improved survival in patients with AIDS, Pneumocystis carinii pneumonia, and severe respiratory failure. Chest. 1989 Oct;96(4):862–866. doi: 10.1378/chest.96.4.862. [DOI] [PubMed] [Google Scholar]
  16. Furrer H., Egger M., Opravil M., Bernasconi E., Hirschel B., Battegay M., Telenti A., Vernazza P. L., Rickenbach M., Flepp M. Discontinuation of primary prophylaxis against Pneumocystis carinii pneumonia in HIV-1-infected adults treated with combination antiretroviral therapy. Swiss HIV Cohort Study. N Engl J Med. 1999 Apr 29;340(17):1301–1306. doi: 10.1056/NEJM199904293401701. [DOI] [PubMed] [Google Scholar]
  17. Gill J. K., Greene L., Miller R., Pozniak A., Cartledge J., Fisher M., Nelson M. R., Soni N. ICU admission in patients infected with the human immunodeficiency virus - a multicentre survey. Anaesthesia. 1999 Aug;54(8):727–732. doi: 10.1046/j.1365-2044.1999.00903.x. [DOI] [PubMed] [Google Scholar]
  18. Hirschtick R. E., Glassroth J., Jordan M. C., Wilcosky T. C., Wallace J. M., Kvale P. A., Markowitz N., Rosen M. J., Mangura B. T., Hopewell P. C. Bacterial pneumonia in persons infected with the human immunodeficiency virus. Pulmonary Complications of HIV Infection Study Group. N Engl J Med. 1995 Sep 28;333(13):845–851. doi: 10.1056/NEJM199509283331305. [DOI] [PubMed] [Google Scholar]
  19. Jones J. L., Hanson D. L., Dworkin M. S., Alderton D. L., Fleming P. L., Kaplan J. E., Ward J. Surveillance for AIDS-defining opportunistic illnesses, 1992-1997. MMWR CDC Surveill Summ. 1999 Apr 16;48(2):1–22. [PubMed] [Google Scholar]
  20. Kirk O., Lundgren J. D., Pedersen C., Nielsen H., Gerstoft J. Can chemoprophylaxis against opportunistic infections be discontinued after an increase in CD4 cells induced by highly active antiretroviral therapy? AIDS. 1999 Sep 10;13(13):1647–1651. doi: 10.1097/00002030-199909100-00007. [DOI] [PubMed] [Google Scholar]
  21. Kovacs J. A., Masur H. Prophylaxis against opportunistic infections in patients with human immunodeficiency virus infection. N Engl J Med. 2000 May 11;342(19):1416–1429. doi: 10.1056/NEJM200005113421907. [DOI] [PubMed] [Google Scholar]
  22. Kumar S. D., Krieger B. P. CD4 lymphocyte counts and mortality in AIDS patients requiring mechanical ventilator support due to Pneumocystis carinii pneumonia. Chest. 1998 Feb;113(2):430–433. doi: 10.1378/chest.113.2.430. [DOI] [PubMed] [Google Scholar]
  23. Lathey J. L., Spector S. A. Unrestricted replication of human cytomegalovirus in hydrocortisone-treated macrophages. J Virol. 1991 Nov;65(11):6371–6375. doi: 10.1128/jvi.65.11.6371-6375.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Ledergerber B., Egger M., Opravil M., Telenti A., Hirschel B., Battegay M., Vernazza P., Sudre P., Flepp M., Furrer H. Clinical progression and virological failure on highly active antiretroviral therapy in HIV-1 patients: a prospective cohort study. Swiss HIV Cohort Study. Lancet. 1999 Mar 13;353(9156):863–868. doi: 10.1016/s0140-6736(99)01122-8. [DOI] [PubMed] [Google Scholar]
  25. Ledergerber B., Mocroft A., Reiss P., Furrer H., Kirk O., Bickel M., Uberti-Foppa C., Pradier C., D'Arminio Monforte A., Schneider M. M. Discontinuation of secondary prophylaxis against Pneumocystis carinii pneumonia in patients with HIV infection who have a response to antiretroviral therapy. Eight European Study Groups. N Engl J Med. 2001 Jan 18;344(3):168–174. doi: 10.1056/NEJM200101183440302. [DOI] [PubMed] [Google Scholar]
  26. Lopez Bernaldo de Quiros J. C., Miro J. M., Peña J. M., Podzamczer D., Alberdi J. C., Martínez E., Cosin J., Claramonte X., Gonzalez J., Domingo P. A randomized trial of the discontinuation of primary and secondary prophylaxis against Pneumocystis carinii pneumonia after highly active antiretroviral therapy in patients with HIV infection. Grupo de Estudio del SIDA 04/98. N Engl J Med. 2001 Jan 18;344(3):159–167. doi: 10.1056/NEJM200101183440301. [DOI] [PubMed] [Google Scholar]
  27. Macdonald J. C., Torriani F. J., Morse L. S., Karavellas M. P., Reed J. B., Freeman W. R. Lack of reactivation of cytomegalovirus (CMV) retinitis after stopping CMV maintenance therapy in AIDS patients with sustained elevations in CD4 T cells in response to highly active antiretroviral therapy. J Infect Dis. 1998 May;177(5):1182–1187. doi: 10.1086/515281. [DOI] [PubMed] [Google Scholar]
  28. Mansharamani N. G., Garland R., Delaney D., Koziel H. Management and outcome patterns for adult Pneumocystis carinii pneumonia, 1985 to 1995: comparison of HIV-associated cases to other immunocompromised states. Chest. 2000 Sep;118(3):704–711. doi: 10.1378/chest.118.3.704. [DOI] [PubMed] [Google Scholar]
  29. Miles P. R., Baughman R. P., Linnemann C. C., Jr Cytomegalovirus in the bronchoalveolar lavage fluid of patients with AIDS. Chest. 1990 May;97(5):1072–1076. doi: 10.1378/chest.97.5.1072. [DOI] [PubMed] [Google Scholar]
  30. Millar A. B., Patou G., Miller R. F., Grundy J. E., Katz D. R., Weller I. V., Semple S. J. Cytomegalovirus in the lungs of patients with AIDS. Respiratory pathogen or passenger? Am Rev Respir Dis. 1990 Jun;141(6):1474–1477. doi: 10.1164/ajrccm/141.6.1474. [DOI] [PubMed] [Google Scholar]
  31. Miller V., Mocroft A., Reiss P., Katlama C., Papadopoulos A. I., Katzenstein T., van Lunzen J., Antunes F., Phillips A. N., Lundgren J. D. Relations among CD4 lymphocyte count nadir, antiretroviral therapy, and HIV-1 disease progression: results from the EuroSIDA study. Ann Intern Med. 1999 Apr 6;130(7):570–577. doi: 10.7326/0003-4819-130-7-199904060-00005. [DOI] [PubMed] [Google Scholar]
  32. Montaner J. S., Russell J. A., Lawson L., Ruedy J. Acute respiratory failure secondary to Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A potential role for systemic corticosteroids. Chest. 1989 Apr;95(4):881–884. doi: 10.1378/chest.95.4.881. [DOI] [PubMed] [Google Scholar]
  33. Murray J. F., Felton C. P., Garay S. M., Gottlieb M. S., Hopewell P. C., Stover D. E., Teirstein A. S. Pulmonary complications of the acquired immunodeficiency syndrome. Report of a National Heart, Lung, and Blood Institute workshop. N Engl J Med. 1984 Jun 21;310(25):1682–1688. doi: 10.1056/NEJM198406213102529. [DOI] [PubMed] [Google Scholar]
  34. Nelson M. R., Erskine D., Hawkins D. A., Gazzard B. G. Treatment with corticosteroids--a risk factor for the development of clinical cytomegalovirus disease in AIDS. AIDS. 1993 Mar;7(3):375–378. doi: 10.1097/00002030-199303000-00011. [DOI] [PubMed] [Google Scholar]
  35. Palella F. J., Jr, Delaney K. M., Moorman A. C., Loveless M. O., Fuhrer J., Satten G. A., Aschman D. J., Holmberg S. D. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998 Mar 26;338(13):853–860. doi: 10.1056/NEJM199803263381301. [DOI] [PubMed] [Google Scholar]
  36. Piot P., Bartos M., Ghys P. D., Walker N., Schwartländer B. The global impact of HIV/AIDS. Nature. 2001 Apr 19;410(6831):968–973. doi: 10.1038/35073639. [DOI] [PubMed] [Google Scholar]
  37. Richman D. D. HIV chemotherapy. Nature. 2001 Apr 19;410(6831):995–1001. doi: 10.1038/35073673. [DOI] [PubMed] [Google Scholar]
  38. Saag M. S., Graybill R. J., Larsen R. A., Pappas P. G., Perfect J. R., Powderly W. G., Sobel J. D., Dismukes W. E. Practice guidelines for the management of cryptococcal disease. Infectious Diseases Society of America. Clin Infect Dis. 2000 Apr 20;30(4):710–718. doi: 10.1086/313757. [DOI] [PubMed] [Google Scholar]
  39. Schneider M. M., Borleffs J. C., Stolk R. P., Jaspers C. A., Hoepelman A. I. Discontinuation of prophylaxis for Pneumocystis carinii pneumonia in HIV-1-infected patients treated with highly active antiretroviral therapy. Lancet. 1999 Jan 16;353(9148):201–203. doi: 10.1016/S0140-6736(98)07204-3. [DOI] [PubMed] [Google Scholar]
  40. Tural C., Romeu J., Sirera G., Andreu D., Conejero M., Ruiz S., Jou A., Bonjoch A., Ruiz L., Arnó A. Long-lasting remission of cytomegalovirus retinitis without maintenance therapy in human immunodeficiency virus-infected patients. J Infect Dis. 1998 Apr;177(4):1080–1083. doi: 10.1086/517399. [DOI] [PubMed] [Google Scholar]
  41. Vrabec T. R., Baldassano V. F., Whitcup S. M. Discontinuation of maintenance therapy in patients with quiescent cytomegalovirus retinitis and elevated CD4+ counts. Ophthalmology. 1998 Jul;105(7):1259–1264. doi: 10.1016/S0161-6420(98)97031-2. [DOI] [PubMed] [Google Scholar]
  42. Wachter R. M., Luce J. M., Turner J., Volberding P., Hopewell P. C. Intensive care of patients with the acquired immunodeficiency syndrome. Outcome and changing patterns of utilization. Am Rev Respir Dis. 1986 Nov;134(5):891–896. doi: 10.1164/arrd.1986.134.5.891. [DOI] [PubMed] [Google Scholar]
  43. Wachter R. M., Russi M. B., Bloch D. A., Hopewell P. C., Luce J. M. Pneumocystis carinii pneumonia and respiratory failure in AIDS. Improved outcomes and increased use of intensive care units. Am Rev Respir Dis. 1991 Feb;143(2):251–256. doi: 10.1164/ajrccm/143.2.251. [DOI] [PubMed] [Google Scholar]
  44. Weiss R. A. Gulliver's travels in HIVland. Nature. 2001 Apr 19;410(6831):963–967. doi: 10.1038/35073632. [DOI] [PubMed] [Google Scholar]
  45. Weller I. V., Williams I. G. ABC of AIDS: Treatment of infections. BMJ. 2001 Jun 2;322(7298):1350–1354. doi: 10.1136/bmj.322.7298.1350. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Weverling G. J., Mocroft A., Ledergerber B., Kirk O., Gonzáles-Lahoz J., d'Arminio Monforte A., Proenca R., Phillips A. N., Lundgren J. D., Reiss P. Discontinuation of Pneumocystis carinii pneumonia prophylaxis after start of highly active antiretroviral therapy in HIV-1 infection. EuroSIDA Study Group. Lancet. 1999 Apr 17;353(9161):1293–1298. doi: 10.1016/s0140-6736(99)03287-0. [DOI] [PubMed] [Google Scholar]
  47. Whitcup S. M., Fortin E., Lindblad A. S., Griffiths P., Metcalf J. A., Robinson M. R., Manischewitz J., Baird B., Perry C., Kidd I. M. Discontinuation of anticytomegalovirus therapy in patients with HIV infection and cytomegalovirus retinitis. JAMA. 1999 Nov 3;282(17):1633–1637. doi: 10.1001/jama.282.17.1633. [DOI] [PubMed] [Google Scholar]
  48. Wislez M., Bergot E., Antoine M., Parrot A., Carette M. F., Mayaud C., Cadranel J. Acute respiratory failure following HAART introduction in patients treated for Pneumocystis carinii pneumonia. Am J Respir Crit Care Med. 2001 Sep 1;164(5):847–851. doi: 10.1164/ajrccm.164.5.2007034. [DOI] [PubMed] [Google Scholar]
  49. el-Sadr W., Simberkoff M. S. Survival and prognostic factors in severe Pneumocystis carinii pneumonia requiring mechanical ventilation. Am Rev Respir Dis. 1988 Jun;137(6):1264–1267. doi: 10.1164/ajrccm/137.6.1264. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES