SURVIVAL BENEFITS OF PULMONARY CELLULAR ACTIVATION IN AIDS PATIENTS WITH PNEUMOCYSTIS INFECTION

Pneumocystis carinii pneumonia (PCP) is the most common life-threateni ng, opportunistic infection in patients with acquired immunodeficiency syndrome. Between 1984 and 1987, patients infected with human imnunod eficiency virus (HIV) received bronchoalveolar lavages to confirm PCP diagnosis. Unstained slides containing bronchoalveolar cells from 20 o f these patients were stored. Eight years after the last diagnostic br onchoalveolar lavage, blinded investigators immunohistochemically anal yzed the unstained bronchoalveolar cells for the presence of prolifera ting cells and pneumocystic cysts. A significant association was found between the percentage of activated macrophages and patient survival after diagnostic bronchoalveolar lavage. On chart review, patients wit h higher CD4/CD8 ratios had significantly greater alveolar macrophage activation. The correlation of life span and pulmonary cellular activa tion in these cases (most predating retroviral therapy) suggests the i mportance of pulmonary cellular function to immunity and survival in p atients infected with HIV.