Hemoptysis in HIV-infected patients

Study objective: To define the causes and clinical features of hemoptysis in HIV-infected patients. Design: Retrospective analysis of inpatient medical records for patients with HIV infection and hemoptysis. Setting: A large New York City teaching hospital and tertiary referral center. Patients: Fifty HIV-infected adult patients with 51 episodes of hemoptysis. Results: The incidence of hemoptysis was 1.9%. A definite or presumptive etiology was identified for most (78%) episodes, with infection being the leading cause (80% of episodes with identified etiology). Hemoptysis was most often (40% of episodes with a definite or presumptive etiology) attributed to bacterial pneumonia. Mycobacterium tuberculosis was infrequently the cause of hemoptysis (6%). Mortality, attributed to hemoptysis was 8%. In most patients, hemoptysis was mild (77%) and resolved (78%) without specific treatment. Conclusions: Our retrospective series of HIV-infected patients hospitalized for short-term care in New York City suggests that hemoptysis in this group has diverse causes but usually is infectious in etiology and most often due to bacterial pneumonia. Bleeding is typically mild and resolves without specific treatment, but can occasionally be fatal. Differential diagnosis should be approached with specific reference to this patient population and its unique features.