Comparison of Empyema Thoracis in HIV-Infected and Non-Infected Patients With Regard to Aetiology and Outcome

ABSTRACT

Empyema thoracis remains a problem in developing countries. Human immunodeficiency virus (HIV) is a risk factor for the development of empyema. There is a clinical impression that HIV-infected patients with empyema have worse outcomes. This study was conducted to assess whether HIV infection affected aetiology or outcomes of patients with empyema. A retrospective review was conducted of 172 patients; meeting established criteria for the diagnosis of empyema; who were admitted to Chris Hani Baragwanath Hospital between January 2006 and December 2009. HIV-infected and non-infected patients were evaluated for differences in aetiology and outcomes; including length of stay; surgical intervention and local complications of closed-tube thoracostomy. A sub-analysis of HIV-infected patients stratified according to CD4 cell count and use of antiretrovirals (ARVs) was also performed. Of the 172 patients; 125 (73) were HIV infected; and 47 (27) were non-infected. HIV-infected patients with lower CD4 cell counts were more likely to be diagnosed with clinical tuberculosis. More commonly; the aetiology of empyema was not determined in HIV-non-infected patients. HIV-infected patients on ARVs were more likely to have thoracic surgery and had shorter hospital stays than those not on ARVs. This study failed to demonstrate any significant differences in aetiology among HIV-infected vs. non-infected patients with empyema. There was a trend towards more Gram-negative infections in the HIV-infected group. ARV use was associated with improved outcomes with regard to cardiothoracic intervention and length of hospital stay