Study objectives: To determine whether the spectrum of
HIV-related pulmonary disease seen by a university medical center
Pulmonary and Critical Care Medicine Service has changed since the
introduction of highly active antiretroviral therapy (HAART).
Design: Retrospective chart review.
Setting: A tertiary care university hospital.
Patients: All HIV-infected patients referred to the
Pulmonary and Critical Care Medicine Service from January 1, 1993,
through December 31, 1995 (era 1) and from July 1, 1997, through June
30, 2000 (era 2).
Interventions: Inpatient and
outpatient charts were reviewed for data regarding patient
demographics, CD4 cell counts, viral load levels, duration of HIV
seropositivity, history of opportunistic infections, and final
pneumonia (PCP) was less common in the HAART era than in the pre-HAART
era, whereas bacterial pneumonia and non-Hodgkin’s lymphoma (NHL) were
more common in the HAART era than in the pre-HAART era. HAART was
protective against PCP (odds ratio [OR], 0.37; confidence interval[
CI], 0.16 to 0.89) in a manner dependent on the CD4 cell count.
Patients receiving HAART were at increased risk for the development of
bacterial pneumonia (OR, 2.41; CI, 1.12 to 5.17) and NHL (OR, 15.11;
CI, 3.14 to 28.32). A history of PCP indicated a risk factor for
bacterial pneumonia (OR, 2.14; CI, 1.13 to 4.04). A history of
cytomegalovirus infection indicated a risk factor for NHL (OR, 6.0; CI,
1.27 to 28.32).
Conclusions: There have been
significant changes in the spectrum of HIV-related pulmonary
complications seen by our Pulmonary and Critical Care Medicine Service
in the HAART era.