THE CONTINUING UTILITY OF BRONCHOALVEOLAR LAVAGE TO DIAGNOSE OPPORTUNISTIC INFECTION IN AIDS PATIENTS

PURPOSE: TO determine whether bronchoalveolar lavage (BAL) remains a u seful technique in assessing human immunodeficiency virus (HIV)infecte d patients with pulmonary symptoms. PATIENTS AND METHODS: All HIV-infe cted patients with pulmonary symptoms referred to a university hospita l-based pulmonary service underwent bronchoscopy and BAL within 24 hou rs of referral. All samples were handled in a standardized fashion. Th e results of the lavage were compared with chest roentgenograms and cl inical results. RESULTS: A total Of 894 lavages were performed on HIV- infected patients over a 7-year period. The overall diagnostic yield w as 60%, with 420 patients having Pneumocystis carinii. Infections othe r than P carinii were found in 185 cases, including 75 lavages with P carinii and another infection. The other infections included Mycobacte rium tuberculosis (17 patients), Mycobacterium kansasii (15 patients), Histoplasma capsulatum (24 patients), Cryptococcus neoformans (17 pat ients), and bacterial infection (103 patients). For 364 lavages, no di agnosis was made. Chest roentgenograms were not useful in predicting w hat infection would be diagnosed. There was no difference in the yield of BAL over the 7-year period, despite the introduction of aerosol pe ntamidine prophylaxis and antiretroviral therapy. CONCLUSION: Bronchos copy with BAL continues to have a role in the evaluation of HIV-infect ed patients with pulmonary symptoms.