Pulmonary complications in people living with HIV: a retrospective evaluation of the etiological spectrum and mortality-associated factors

Introduction Pulmonary complications are a major cause of poor outcomes in people living with HIV, yet data on the etiology and mortality predictors remain limited, particularly in middle-income countries. Methods In this retrospective cohort study, we reviewed the clinical records of 117 adults living with HIV (PLWH) with documented pulmonary involvement followed at a tertiary care center in Turkey between 2000 and 2024. Baseline immunovirological status was assessed using CD4 + T lymphocyte counts and plasma HIV-1 RNA levels. Clinical, laboratory, radiological, and microbiological data were collected, and predictors of mortality and length of hospital stay were analyzed. Results A total of 117 PLWH were included; the cohort was predominantly male (91.5%), with a mean age of 44.0 ± 13.7 years, and 45.3% were receiving antiretroviral therapy at presentation. Infectious etiologies, particularly pneumonia (94.9%), predominated. Microbiological confirmation was obtained in 26 patients (22.2%); across the cohort, a total of 39 pathogens were identified (33.3% when counted by pathogen episode), with SARS-CoV-2 (12.8%) and Mycobacterium tuberculosis complex (6.0%) being the most common. Non-infectious pulmonary conditions (such as lung cancer, COPD, asthma, and interstitial lung disease) were observed only in a small minority of patients and, owing to their low numbers, were described descriptively but not analyzed in separate outcome subgroups. The overall mortality rate was 24.8% (29/117). The factors significantly associated with mortality included a low CD4 count (160.4 vs. 288.1 cells/mm³; p = 0.014), low albumin level (2.64 vs. 3.13 g/dL; p = 0.003), the need for intubation (OR 70.69, 95% CI 8.63-578.79; p Conclusions Pulmonary involvement in HIV remains a serious clinical issue in our setting and was driven predominantly by infectious pneumonias, whereas non-infectious pulmonary conditions were less frequent and could not be evaluated in detail. Early identification of high-risk patients and increased access to preventive strategies, particularly vaccination, are crucial to improving in-hospital outcomes. Clinical trial number Not applicable.