• Kuan-Yeh Lee, Chao-Chi Ho, Dar-Der Ji, Chang-Min Lee, Mao-Song Tsai, Aristine C Cheng, Pao-Yu Chen, Shin-Yen Tsai, Yu-Tzu Tseng, Hsin-Yun Sun, Yi-Chien Lee, Chien-Ching Hung, and Shan-Chwen Chang.
• Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
• J Microbiol Immunol Infect. 2013 Dec 1;46(6):433-40.

ObjectivesWe aimed to investigate the etiology of pulmonary complications of human immunodeficiency virus-(HIV)-1-infected patients in Taiwan in the era of combination antiretroviral therapy (cART).MethodsFrom July 2009 to March 2012, a prospective observational study was conducted to identify the etiology of pulmonary complications in HIV-1-infected patients who sought HIV care at a university hospital in Taiwan. A stepwise diagnostic approach was adopted, which included radiography, serology, microbiology, bronchoscopy or video-assisted thoracoscopic surgery, and polymerase chain reaction assays for cytomegalovirus and Pneumocystis jirovecii.ResultsDuring the study period, a total of 203 episodes of pulmonary complications that occurred in 190 patients with a mean CD4 count of 123 × 10(6) cells/L were analyzed. Thirty-eight episodes (18.7%) occurred in patients with a CD4 count >200 × 10(6) cells/L, 71 (35.0%) between 50 and 200 × 10(6) cells/L, and 94 (46.3%) <50 × 10(6) cells/L. Pneumocystis pneumonia accounted for more than half of the complications in patients with a CD4 count <200 × 10(6) cells/L. In patients with a CD4 count >200 × 10(6) cells/L, the etiology of pulmonary complications was diverse, with bacterial infections (47.4%) being the most common, followed by tuberculosis (15.8%) and lung edema (13.2%). Pneumocystosis and cytomegalovirus pneumonitis were seen mostly or exclusively in patients with a CD4 count <200 × 10(6) cells/L and were the leading causes of interstitial pneumonitis. On the other hand, empyema, legionellosis, and lung edema were more commonly seen in patients with a CD4 count >200 × 10(6) cells/L.ConclusionsThe etiology of pulmonary complications in HIV-1-infected patients was diverse and varied with the categories of CD4 counts. Pneumocystosis remained the leading cause of pulmonary complications in patients with lower CD4 counts in Taiwan in the cART era.Copyright © 2012. Published by Elsevier B.V.

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