DIAGNOSIS OF PULMONARY KAPOSIS-SARCOMA BY DETECTION OF HUMAN HERPES-VIRUS-8 IN BRONCHOALVEOLAR LAVAGE

Human herpes virus 8 (HHV8) DNA has recently been detected in sarcoma tissue of patients with Kaposi's sarcoma. HHV8 DNA could also be found in bronchoalveolar lavage (BAL) fluid of patients with tracheobronchi al Kaposi's sarcoma. To determine the specificity, sensitivity and pre dictive values of HHV8 DNA detection in the BAL for the diagnosis of p ulmonary Kaposi's sarcoma, 100 consecutive BAL were prospectively anal yzed for the presence of HHV8 DNA using a nested PCR assay. In additio n, 19 BAL samples of 14 AIDS patients with cutaneous or visceral Kapos i's sarcoma were retrospectively investigated. The prospective group c onsisted of 79 BAL performed in immunocompromised and of 21 BAL in non immunocompromised patients. Four patients of the prospectively analyze d group undergoing six BAL showed tracheobronchial Kaposi's sarcoma at five bronchoscopies. All of the five BAL samples performed in these p atients with endoscopically visible Kaposi's sarcoma were positive for HHV8 DNA. Following chemotherapy and antiretroviral treatment tracheo bronchial Kaposi's sarcoma was no longer detectable at a subsequent br onchoscopy and HHV8 DNA in BAL became negative in one patient. One BAL sample of a HIV-positive patient with no evidence of Kaposi's sarcoma was HHV8 DNA-positive. The sensitivity, specificity, positive and neg ative predictive values of HHV8 detection for the diagnosis of tracheo bronchial Kaposi's sarcoma were 100%, 98.9%, 83.3%, and 100%, respecti vely. Twelve of 19 BAL samples of the retrospective group were HHV8 DN A-positive. In this group, 10 patients undergoing a total of 14 BAL su ffered from pulmonary Kaposi's sarcoma. HHV8 DNA was documented in 10 of these 14 BAL samples. In three BAL of this group HHV8 DNA was posit ive, but pulmonary Kaposi's sarcoma was diagnosed at a later stage. In conclusion, the detection of HHV8 DNA in BAL is restricted to patient s with Kaposi's sarcoma and is highly sensitive and specific for pulmo nary involvement of Kaposi's sarcoma.