Ri. Sternberg et al., PNEUMOCYSTIS-CARINII ALTERS SURFACTANT PROTEIN-A CONCENTRATIONS IN BRONCHOALVEOLAR LAVAGE FLUID, The Journal of laboratory and clinical medicine, 125(4), 1995, pp. 462-469
Citations number
46
Categorie Soggetti
Medical Laboratory Technology","Medicine, General & Internal
To understand better the interaction between surfactant protein A (SP-
A), human immunodeficiency virus (HIV) and Pneumocystis carinii pneumo
nia (PCP), we measured SP-A from bronchoalveolar lavage (BAL) fluid in
immunosuppressed patients (HIV-positive [HIV+] and HIV noninfected [H
IV-]) who were examined for possible pneumonia. Forty-five HIV+ patien
ts, 16 with PCP and no other pathogen (HIV+/Pc) and 29 with no evidenc
e of pulmonary pathogen [HIV+ controls), were compared with 6 HIV- pat
ients with PCP (HIV-/Pc) and 11 control patients with no underlying di
sease (controls). Despite a similar inflammatory response in the HIV-i
nfected patients whether they had PCP or not, we found increased BAL S
P-A concentrations in HIV+/Pc patients as compared with HIV+ control p
atients (HIV+/Pc: median, 10.3 mu g/ml; range, 2.8 to 24.3 mu g/ml; HI
V+ control: median, 1.9; range, 0.06 to 3.83 mu g/ml; p < 0.05). The a
mount of SP-A in the HIV+ control group was significantly lower than h
ealthy, uninfected volunteers, suggesting that HIV itself may lower SP
-A levels. Six HIV+/Pc patients underwent BAL after 21 days of therapy
and showed complete resolution of the P. carinii organism. There was
a significant drop in the amount of SP-A at follow-up lavage (initial
mean, 14.1 mu g/ml; follow-up mean, 7.4 mu g/ml; p < 0.02). We also fo
und a significant correlation between the amount of P. carinii and the
amount of SP-A in the BAL fluid (Spearman rank, 0.74; p < 0.01). We c
onclude that SP-A content is increased in HIV+ patients with PCP. The
relationship between SP-A concentration and the abundance of P. carini
i present in the BAL fluid may be related to SB-A binding to P. carini
i or to alterations in surfactant protein homeostasis.