BRONCHOALVEOLAR LAVAGE PHOSPHOLIPID ABNORMALITIES IN HIV-INFECTED PATIENTS

Our aim was to evaluate the quality of pulmonary surfactant, a non-spe cific defence system, during the course of human immunodeficiency viru s) infection. Protein and phospholipid composition were determined in 127 bronchoalveolar lavage (BAL) fluids from 89 HIV seropositive patie nts (54 acquired immune deficiency syndrome (AIDS), 35 non-AIDS) and 1 1 healthy controls. In all of the HIV BAL samples, biochemical abnorma lities were found. In subjects with pulmonary infection or Kaposi's sa rcoma, the phospholipid/protein ratio was decreased, mainly because of elevated protein levels (15.8 and 20, respectively, vs 7.2 mg-100 ml- 1 for controls, p<0.05). In subjects without obvious pulmonary involve ment, phospholipid was decreased (1.3+/-0.2 vs 29+/-0.3 mg.100 ml-1 fo r controls, p<0.001), whereas the protein was not altered. Phospholipi d composition was also altered: the phosphatidylcholine percentage was decreased, whilst the other main phospholipids were increased. We con clude that the alveolar lining is altered, whatever the stage of HIV d isease. In most patients, it results from an increase of vascular perm eability, with an influx of serum proteins. However, changes in phosph olipid composition suggest that, in some cases, surfactant is also alt ered.