PULMONARY COMPLICATIONS OF HIV-INFECTION IN DAR-ES-SALAAM, TANZANIA -ROLE OF BRONCHOSCOPY AND BRONCHOALVEOLAR LAVAGE

To determine the pulmonary complications in HIV-1-infected patients in Dar es Salaam, Tanzania, and to evaluate the diagnostic utility of br onchoscopy and bronchoalveolar lavage, we carried out a prospective st udy of 237 patients with acute respiratory disease who were hospitaliz ed at Muhimbili Medical Center (MMC). Diagnoses were made using well-d efined criteria. Of the total, 127 (54%) were HIV-1-seropositive and 1 10 (46%) were seronegative. Tuberculosis was the most common diagnosis occurring in 95 (75%) HIV-1-seropositive and 87 (79%) seronegative pa tients. Bacterial pneumonia was the next most common diagnosis occurri ng in 18 (14%) HIV-1-seropositive and 17 (15%) seronegative patients. Pneumocystis carinii pnemonia was diagnosed in one and Kaposi's sarcom a was seen in only two HIV-1-seropositive patients. Bronchoscopy with bronchoalveolar lavage was the sole source of a diagnosis in nine (8%) seropositive and six (5%) seronegative patients. We conclude that the HIV seroprevalence rate among patients hospitalized for acute respira tory disease at MMC is extremely high. Tuberculosis was the most commo n cause of pulmonary disease, regardless of HIV serostatus, and other HIV-associated opportunistic pulmonary infections were unusual. Bronch oscopy with bronchoalveolar lavage added little to the diagnosis and t hus should not be high-priority procedures for the routine workup in r esource-poor areas where tuberculosis is endemic.