CYTOMEGALOVIRUS PNEUMONIA IN AIDS PATIENT - VALUE OF CYTOMEGALOVIRUS CULTURE FROM BAL FLUID AND CORRELATION WITH LUNG-DISEASE

Objectives: To verify the value of cytomegalovirus (CMV) cultures of B AL fluid vs postmortem lung histopathology in detecting CMV pneumonia, and to correlate the BAL viral dose with the number of CMV inclusion bodies (CMV-IB) in the lung tissue of AIDS patients. Design: Retrospec tive analysis of 434 BALs and 40 autopsies involving 307 AIDS patients ; clinical follow-up lasted 10 months. Patients and methods: The 40 pa tients who died within 20 days of undergoing BAL were divided on the b asis of histopathologic findings into subjects with and without CMV-IB in the lung tissue. The relationship between the BAL viral dose and C MV lung infection was evaluated by counting the early antigen (CMV-EA) positive cells/200 mu L of BAL and the number of CMV-IB/mm(2) of lung tissue. Results: The predictive value of BAL virus isolation for the diagnosis of CMV pneumonia was 61% for positive and 100% for negative results. The patients with the largest number of CMV-IB had CMV-EA cou nts from 2 to 840; in those with a moderate and small number, the CMV- EA counts were, respectively, from 11 to 700 and 2 to 300. Among the p atients surviving up to 10 months after the BAL index sample, the freq uency of recurrent extrapulmonary CMV abnormalities was 27% in those w ith positive and 7% in those with negative cultures. Conclusions: BAL CMV cultures from AIDS patients have a very high negative and relative ly low positive predictive value for CMV pneumonia. The presence and r eplication of CMV in the lung may lead to systemic dissemination as su ggested by the higher probability of CMV extrapulmonary diseases. Vira l titers do not seem to be related to the degree of lung damage.