LACK OF CLINICAL UTILITY OF BRONCHOALVEOLAR LAVAGE CULTURES FOR CYTOMEGALOVIRUS IN HIV-INFECTION

This study assessed the presence of cytomegalovirus (CMV) in bronchoal veolar ravage (BAL) in three subpopulations of HIV-infected patients a nd correlated its presence with clinical status during 3 mo of follow- up. Nineteen asymptomatic volunteers, six patients with CMV retinitis, and 46 patients with acute pulmonary symptoms underwent BAL and were assessed for CMV by cytopathology, conventional shell vial cultures, a nd antigen detection. Transbronchial biopsies were also obtained when possible and evaluated for histopathologic changes of CMV. All patient s were followed for approximately 3 mo. Cytomegalovirus was detected i n BAL in nine of 19 (47%) asymptomatic volunteers, in all six patients with CMV retinitis, and in 33 of 46 (72%) patients with pulmonary sym ptoms. Only one symptomatic patient with a positive CMV BAL culture de veloped clinically significant CMV pulmonary disease; this patient dev eloped disseminated CMV and died. The only other death occurred in a p atient with CMV retinitis who developed staphylococcal bacteremia. Non e of the asymptomatic volunteers or patients with CMV retinitis develo ped evidence of CMV pneumonia or any other organ disease with CMV. Cyt omegalovirus is frequently detected in BAL from HIV-infected patients regardless of their pulmonary symptoms and its presence does not clini cally predict significant pulmonary morbidity or mortality in 3 mo of follow-up.