ACCELERATED OBSTRUCTIVE PULMONARY-DISEASE IN HIV-INFECTED PATIENTS WITH BRONCHIECTASIS

Human immunodeficiency virus (HIV) infection has been associated with a wide spectrum of pulmonary disease. We report three HIV-seropositive patients with rapidly worsening airway obstruction associated with br onchiectasis. All subjects (age range 33-39 yrs) were cigarette smoker s. Two had previously used intravenous drugs. The CD4 lymphocyte count ranged 40-250 cells . mm(-3). All individuals had complained of incre asing dyspnoea for 3-6 months. Within 1 yr, they all developed severe airway obstruction with a decrease in both forced expiratory volume in one second (FEV1) and ratio of FEV1 to forced vital capacity (FEV1/FV C) to less than 60% of predicted value, and a decrease in mean forced expiratory flow at 25-75% of the forced vital capacity (FEF25-75) to l ess than 35% of predicted value. Computed tomography of the chest disc losed bilateral dilated and thickened bronchi. No classical causes of genetic or acquired bronchiectasis were identified in our patients. Re current bacterial bronchitis occurred in the follow-up period of the t hree patients. In conclusion, unusually rapid airway obstruction assoc iated with bronchiectasis should be added to the wide spectrum of resp iratory complications of human immunodeficiency virus infection.