Pneumocystis carinii pneumonia in HIV-infected patients: effect of steroidtherapy on surfactant level

Previous studies have suggested alterations in pulmonary surfactant lipid i n the setting of Pneumocystis carinii pneumonia in HIV-infected patients. B ecause pulmonary surfactant lipid is composed of a variety of lipid product s and because other phospholipids might be present in bronchoalveolar lavag e (BAL) lipid determinations, a single molecular species of phospholipid wh ich comprises a substantial portion of the surfactant lipid fraction, dipal mitoyl phosphatidylcholine (DPPC), was measured by capillary column gas chr omatography in BAL samples taken at the time of the diagnosis of P. carinii pneumonia, and 10 days after treatment for P. carinii pneumonia. DPPC was measured at day 0 and day 10 in seven patients who had been randomized to r eceive methylprednisolone adjuvant therapy for P. carinii pneumonia and in six patients who had been randomized to not receive methylprednisolone ther apy. The level of DPPC in BAL from all patients at day 0 was 0.49 +/- 0.06 mu g ml(-1) BAL. This level is significantly lower that the level of DPPC d etermined in BAL from five normal volunteers 2.48 +/- 0.40 mu g ml(-1). At day 0, the BAL level of DPPC in patients treated with methylprednisolone wa s not different from the BAL level of DPPC in patients not treated with met hylprednisolone. By day 10 of therapy for P. carinii pneumonia, BAL levels of DPPC in all patients had increased to 1.05 +/- 0.19 mu g ml(-1) BAL. At day 10 DPPC levels in the methylprednisolone treated group were not differe nt from the group not treated with methylprednisolone. We conclude that in HIV-infected patients, lung surfactant lipid is reduced in the setting of P . carinii pneumonia. The lipid levels return toward normal levels with trea tment. Adjuvant therapy with corticosteroids does not alter the rate of rec overy of surfactant lipid levels at least after 10 days of therapy.