THE ROLE OF BRONCHOSCOPY IN THE DIAGNOSIS AND TREATMENT OF PULMONARY-DISEASE IN HIV-INFECTED PATIENTS

Background: Pulmonary disease is the most common reason for presentati on and the major cause of death in HIV-infected patients. There has be en an evolution in the optimal approach to the investigation of a pulm onary infiltrate in HIV-infected patients since the introduction of in duced sputum for the diagnosis of Pneumocystis carinii pneumonia (PCP) . Aims: To evaluate the usefulness of flexible fibreoptic bronchoscopy (FFB), bronchoalveolar lavage (BAL), transbronchial biopsy (TBB) and bronchial brushings (BB) in the diagnosis of pulmonary disease in HIV- infected patients and to examine the effect of FFB on changes in thera py and survival. Methods: The histories of all HIV-infected patients r eferred to Fairfield Hospital for FFB between January 1990 and June 19 93 were examined retrospectively.Results: Forty-two FFB were performed on 41 patients (40 male and one female). Definitive diagnoses made at FFB included Kaposi's sarcoma (KS) (n = 9), invasive aspergillosis (n = 5), PCP (n = 4), Mycobacterium avium complex (MAC) pneumonia (n = 2 ), cytomegalovirus (CMV) pneumonia (n = 1), Cryptococcus neoformans pn eumonia (n = 1), microsporidium (n = 1) and Pseudomonas aeruginosa pne umonia (n = 1). TEE and BE did not provide a diagnosis for diseases no t seen macroscopically at FFB or diagnosed by BAL. FFB findings altere d diagnosis in 21/42 (50%) presentations and changed therapy in 26/42 (62%) cases. Conclusion: FFB together with BAL altered the working dia gnosis and changed therapy in a significant number of patients. TBB an d BE should not be routinely performed in all patients as these proced ures are of limited value in this setting.