RELATION OF HIV-I IN BRONCHOALVEOLAR LAVAGE CELLS TO ABNORMALITIES OFLUNG-FUNCTION AND TO THE PRESENCE OF PNEUMOCYSTIS PNEUMONIA IN HIV-I SEROPOSITIVE PATIENTS

Background-HIV is present in bronchoalveolar lavage cells of some but not all HIV seropositive patients. Abnormalities of lung function have been described in such patients in the absence of clinically overt pn eumonia or other respiratory infections. It is possible that the prese nce of HIV in alveolar macrophages could account for these abnormaliti es. It is also possible that the presence of HN in alveolar macrophage s contributes to immunosuppression and an increased incidence of oppor tunistic infections. Methods-This was a prospective study of 157 HIV s eropositive patients requiring diagnostic bronchoscopy for investigati on of new respiratory symptoms, chest radiograph abnormality, or pneum onic illness. Presence of HIV in bronchoalveolar lavage cells obtained at diagnostic bronchoscopy was determined by polymerase chain reactio n to detect proviral DNA and in vitro cocultivation to detect producti ve virus infection. With these two techniques the presence or absence of HIV in bronchoalveolar lavage was compared with the presence of abn ormalities of lung function or presence of Pneumocystis pneumonia. Res ults-HIV was detected in bronchoalveolar lavage cells in 65% of patien ts by means of the polymerase chain reaction and 59% with cocultivatio n. With both methods of detection there was no association between the presence or absence of HIV and the presence of Pneumocystis pneumonia ; nor was there a relation between the presence of HIV and abnormaliti es of lung function. Conclusion-The presence of HIV in bronchoalveolar lavage cells does not predispose to an increased incidence of Pneumoc ystis pneumonia; nor does it contribute to abnormalities of lung funct ion.