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The pulmonary physician in critical care • Illustrative case 5: HIV associated pneumonia
  1. R J Boyton,
  2. D M Mitchell,
  3. O M Kon
  1. Chest and Allergy Department, St Mary’s Hospital NHS Trust, London W2 1NY, UK
  1. Correspondence to:
    Dr R Boyton, Chest and Allergy Department, St Mary’s Hospital NHS Trust, London W2 1NY, UK;
    r.boyton{at}ic.ac.uk

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The case history is presented of a patient with HIV associated pneumonia who was successfully treated in the ICU. The mortality rate of HIV infected patients admitted to the ICU has improved since the introduction of prophylaxis for Pneumocystis carinii pneumonia and highly active antiretroviral therapy (HAART). The identification of objective outcome predictors will help clinicians to decide when to pursue aggressive treatment and when to withhold or withdraw it.

An estimated 36 million people worldwide are currently infected with HIV, about 1.46 million in North America and Western Europe and a further 25.3 million in sub-Saharan Africa.1 An estimated 30 000 adults and children became infected with HIV in Western Europe during the year 2000. The continuing rate of infection, coupled with longer survival due to primary and secondary prophylaxis against opportunistic infection and highly active antiretroviral therapy (HAART), has resulted in the prevalence continuing to increase.1,2

Infection with HIV is associated with increased susceptibility to opportunistic infection with more than 100 viruses, bacteria, protozoa and fungi.3 Primary and secondary prophylaxis against opportunistic infections and HAART has led to changes in the nature, incidence, and presentation of opportunistic infections such as Pneumocystis carinii pneumonia (PCP), Mycobacterium avium intracellulare (MAI) ,and cytomegalovirus (CMV) retinitis.2,4 New challenges are presented to physicians in medical high dependency units (HDUs) and intensive care units (ICUs). We report a patient who presented with HIV associated pneumonia and discuss the issues concerning admission to HDU/ICU of HIV infected individuals in the PCP prophylaxis and post-HAART era, drawing together current views of prognostic indicators and outcomes.

CASE REPORT

A 39 year old white man presented with a 3 week history of increasing shortness of breath accompanied by a non-productive cough, fever, and 5 kg weight loss. A diagnosis of HIV infection with …

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