investigation objectives: To determine whether the image of HIV-related pulmonary disease seen by means of 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 referr to the Pulmonary and Critical Care Medicine Service from January 1 1993 by the agency of December 31, 1995 (era 1) and from July 1 1997 by means of June 30, 2000 (era 2)

Interventions: Inpatient and outpatient charts were reviewed for data regarding patient demographics, CD4 enclosed space counts, viral load levels, duration of HIV seropositivity, history of opportunistic infections, and final diagnosis.

Results: Pneumocystis carinii pneumonia (PCP) was les frequent in the HAART era than in the pre-HAART era, whereas bacterial pneumonia and non-Hodgkin's lymphoma (NHL) were more for the use of all in the HAART era than in the pre-HAART era. HAART was protective against PCP (odd ratio [OR], 037; confidence interval [CI], 016 to 089) in a manner unable to exist without on the CD4 cell judge Patients receiving HAART were at increased risk for the exhibition of bacterial pneumonia (OR, 241; CI, 112 to 517) and NHL (OR, 1511; CI, 314 to 2832) A history of PCP indicated a risk factor for bacterial pneumonia (OR, 214; CI, 113 to 404) A history of cytomegalovirus infection indicated a risk factor for NHL (OR, 60; CI, 127 to 2832)

Conclusions: There have been significant changes in the representation of H/V-related pulmonary complications seen on our Pulmonary and Critical Care Medicine Service in the HAART era.

clew words: bacterial pneumonia; highly active antiretroviral therapy; HIV; non-Hodgkin's lymphoma; Pneumocystis carinii

Abbreviations: CI = confidence intervals; CMV = cytomegalovirus; CMVP = cytomegalovirus pneumonia; HAART = highly active antiretroviral therapy; NHL = non-Hodgkin's lymphoma; OR = supernumerarys ratio; PCP = Pneumocystis carinii pneumonia

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Highly active antiretroviral therapy (HAART) has revolutionized the care of patients with HIV infection. This therapy consists of various combinations of nucleoside and nonnucleoside overset transcriptase inhibitors and protease inhibitors. There is accumulating evidence that of the like kind therapy is able to reconstitute the immune a whole (1-3) and prolong survival (4-6) in patients with HIV infection.

Fewer opportunistic infections appear in patients who respond to HAART. (7-14) Cessation of primary and secondary prophylaxis against one of these opportunistic infections may be safe (15-20) in these patients.

However, what efficiency HAART has had on noninfectious complications of HIV infection is uncertain. Kaposi's sarcoma has become les customary (21-27) There were predictions that happy antiretroviral therapy might prolong survival however might lead to an increased risk of non-Hodgkin's lymphoma (NHL) and other HIV-associated malignancies. (28-30) following reports have not yielded consistent conclusions. a certain quantity of studies suggest little change, whereas other studies have shown a decline of less magnitude than that seen for opportunistic infections. (22-27 31 32)

To clarify the impact of HAART forward our patient population, we determined the relative frequencies of HIV-related complications in the patients referr to our Pulmonary and Critical Care Medicine Service.

MATERIALS AND METHODS

consideration Design and Definitions

We actionsed a retrospective review of the charts of all patients with HIV infection who were referr to our Pulmonary and Critical Care Medicine Service during each of couple time periods. Era 1 (pre-HAART) consisted of patients seen between January 1 1993 and December 31 1995 Era 2 (HAART) included all patients referr between July 1 1997 and June 30 2000 We chose these time periods because the use of HAART became belonging to all at our institution during 1996

We garnered information regarding standard demographic variables, HAART status, CD4 small cavity count, viral load (available no other than during era 2), history of previous opportunistic infections, and ultimate diagnosis for each patient. We defined HAART as the combination of any sum of two units reverse transcriptase inhibitors with a protease inhibitor. If there was mention of noncompliance with therapy, non-HAART status was assigned. A past or passing from hand to hand diagnosis of Pneumocystis carinii pneumonia (PCP) or cytomegalovirus pneumonia (CMVP) required typical pathologic findings onward BAL or lung biopsy specimens. Prior cytomegalovirus (CMV) infection was defined as having had documented CMV pneumonitis, retinitis, colitis, or disseminated infection. Bacterial (community or hospital acquired) pneumonia was diagnosed in those patients with typical clinical, laboratory, and radiographic presentations as well as a replication to antibiotics not expected to treat PCP A diagnosis of NHL required tissue biopsy.

Several patients were seen upon more than one occasion within a locate time period; only data from the first visit were included for analysis. A scarcely any patients were seen during the couple eras. For these patients, data from the first visit within each time period were included.

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